Columbia  Wlnihttsiit^ 
in  tfje  Citp  of  Jgeio  |?ork 

College  of  ^jipsficiansi  anb  burgeons; 


l^eference  %ihvav^ 


STUTTERING  AND   LISPING 


THE  MACMILLAN  COMPANY 

NEW  YORK  •    BOSTON   •    CHICAGO 
DALLAS  •    SAN   FRANCISCO 

MACMILLAN  &  CO.,  Limited 

LONDON  •    BOMBAY  •    CALCUTTA 
MELBOURNE 

THE  MACMILLAN  CO.  OF  CANADA,  Ltd. 

TORONTO 


STUTTERma  AND  LISPING 


BY 

E.  W.  SCRIPTURE,  Ph.D.  (Leipzig),  M.D.  (Munich) 

ASSOCIATE  IN   PSYCHIATRY,    COLUMBIA  UNIVERSITY;    DIRECTOR 
OF  THE  RESEARCH  LABORATORY   OF   NEUROLOGY,    VAN- 
DERBILT    CLINIC  ;      FORMERLY    ASSISTANT    PRO- 
FESSOR OF   EXPERIMENTAL    PSYCHOLOGY, 
TALE   UNIVERSITY 


THE  MACMILLAN  COMPANY 
1917 

All  rights  reserved 


COPTEIGHT,  1913, 

By  the  MACMILLAN  COMPANY. 


Set  up  and  electrotyped.     Published  Novemoer,  iqi2 
Reprinted    October    1914.    August,  1917. 


PKEFACE 

It  would  be  difficult  to  find  a  group  of  people  more 
neglected  by  medicine  and  pedagogy  than  that  of 
stutterers  and  lispers.  The  stuttering  children  that 
encumber  the  schools  are  a  source  of  merriment  to 
their  comrades,  a  torment  to  themselves,  and  an  irri- 
tating distraction  to  the  teacher.  As  they  grow  older, 
the  stutterers  suffer  tortures  and  setbacks  that  only 
dauntlessness  or  desperation  enable  them  to  survive. 
The  lispers  that  are  so  numerous  in  certain  schools  are 
a  needless  retardation  to  the  classes. 

In  several  European  countries  the  state  has  estab- 
lished special  opportunities  for  treating  children  with 
speech  defects,  but  the  matter  has  not  received  the 
full  attention  justified  by  its  importance.  In  most 
medical  faculties  no  place  is  accorded  to  speech  defects  ; 
the  same  is  true  in  schools  of  pedagogy.  This  was 
formerly  justified  on  the  ground  that  a  scientific  study 
of  speech  and  its  defects  did  not  exist.  In  the  last 
decade,  however,  the  science  of  phonetics  has  extended 
itself  to  laboratory  work  and  university  teaching; 
moreover,  speech  clinics  have  been  established  in  sev- 
eral of  the  foremost  medical  schools.  The  treatment 
of  these  defects  thus  stands  upon  an  entirely  new  basis ; 
namely,  that  of  a  carefully  developed  science  of  normal 
and  pathological  speech. 

V 


yn  PREFACE 

The  views  here  expressed  as  to  the  nature  of  stutter- 
ing and  lisping,  and  the  methods  of  treatment  proposed 
are  the  results  of  three  lines  of  work.  The  first  is  a 
long  experience  in  experimental  psychology  in  the 
laboratory  of  the  University  of  Leipzig  and  later  in 
my  own  laboratory  at  Yale  University.  The  second 
is  an  almost  equally  long  specialization  in  experimental 
phonetics,  beginning  at  Yale  and  continued  for  four 
years  in  Germany  under  a  grant  from  the  Carnegie 
Institution  of  Washington,  D.C.  ;  some  of  the  results 
involved  were  first  stated  in  my  lectures  at  the  Uni- 
versity of  Marburg  (Germany).  Finally,  the  treat- 
ment of  thousands  of  patients  in  the  speech  department 
of  the  Vanderbilt  Clinic  and  in  private  practice  has 
developed  the  methods  into  forms  that  produce  the 
maximum  result  with  the  minimum  expenditure  of 
time. 

This  book  has  been  prepared  to  meet  the  needs  of 
physicians  and  teachers  ;  both  are  constantly  confronted 
with  the  problem  of  what  is  to  be  done  with  a  lisping 
or  a  stuttering  child.  By  careful  study  of  the  symp- 
toms as  described  here  and  by  plentiful  experience  in  a 
speech  clinic  a  physician  may  expect  within  a  reason- 
able time  to  develop  the  ability  to  make  a  correct  diag- 
nosis. A  correct  diagnosis  by  an  expert  should  always 
be  obtained  before  treatment  is  begun.  The  treatment 
of  lisping  proceeds  along  such  clearly  marked  lines  that 
the  general  practitioner  and  the  regular  teacher  will 
have  no  difficulty  in  treating  the  individual  cases  that 
come  to  him  in  practice  or  in  class.  The  results  are  al- 
ways gratifying ;  the  parent  appreciates  the  seriousness 
of   the   defect,  and   the  cure   usually  occurs   without 


PREFACE  Vll 

great  difficulty.  The  treatment  of  stutteriiif^  is  uiiich 
more  difficult ;  it  requires  great  skill  and  long  experi- 
ence. There  should  be  at  least  one  physician  in  each 
town  who  is  able  to  help  the  numerous  stutterers  who 
must  otherwise  be  neglected.  One  teacher  in  a  school 
or  in  a  group  of  schools  may  be  trained  as  a  special 
instructoi'. 

I  have  to  thank  Professor  H.  Gutzmann,  of  the  Uni- 
versity of  Berlin,  for  his  kindness  in  specially  modeling 
the  plaster  cast  shown  in  Fig.  39,  and  Mr.  Walter 
Robinson  for  the  suggestion  illustrated  in  Figs.  90,  91. 

College  of  Physicians  and  Surgeons, 

Columbia  University,  New  York,  1912. 


CONTENTS 


PAOE 

Preface v 

Contents ix 

List  of  Illustration* xi 


PART   I 

STUTTERHNCr 

I. 

Description.    Cause         .        •        .        . 

1 

II. 

Symptoms,  Forms,  Natt^pk 

.       10 

III. 

Diagnosis    ....... 

.      42 

IV. 

Therapy      ....... 

.      56 

V. 

Methods  of  Treatment 

PAET   11 
LISPING 

.       .     74 

I. 

Introduction     ...                .        . 

.       .    Ill 

II. 

Negligent  Lisping    .        .                .        • 

.    122 

III. 

Organic  Lisping        ..... 

.    162 

IV. 

Neurotic  Lisping      ... 

.    173 

V. 

Cluttering         .        .       •       • 
PART   III 

.    181 

SET 
I. 

EXERCISES 
Breathing 

19G 

II. 

Melody       .        .        .        .        .        •        • 

194 

IZ 


X  CONTENTS 

8BT  PAGE 

m.    Flexibility .  197 

IV.    Slowness 198 

V.    Smoothness .  201 

VI.  Voice  Quality        .        .        .        .        .        .        .  202 

VII.  Starting  and  Ending  Sentences       .        .        .  205 

VIII.    Enunciation  and  Spelling 207 

IX.     Expression 208 

X.    Confidence 210 

XL  Spontaneous  Speech     .        .        .        .        ,        .  216 

XII.     Thinking 217 

XIII.  Description  and  Relation          ....  219 

XIV.  Telephoning 221 

XV.    Talking  with  People 222 

XVI.    Relaxation 224 

XVn.    Muscular  Control 225 

XVIIL    Word  Lists 228 

SELECTED  REFERENCES 245 

TECHNICAL  TERMS 246 

INDEX 249 


LIST   OF  ILLUSTRATIONS 


1.  Recording  the  movements  of  breathing  by  the  graphic 

method 21* 

2.  Breath  record  during  stuttering 23 

3.  Recording  the  pressure  of  the  lips  by  the  graphic  method  23 

4.  Lip  record  of  a  stutterer's  attempt  to  say  the  first  letter 

in  the  word  "  Peter  " 24 

5.  Recording  the  movements  of  the  tongue           ...  24 

6.  Record  of  a  stutterer's  cramps  of  the  tongue  in  attempt- 

ing to  say  "  Tommy " 25 

7.  Recording  the  mouth  current 26 

8.  Mouth  record  of  "papa"  spoken  normally        .        .      •  .  27 

9.  Mouth  record  of  "  papa  "  with  blowy  "  p*s  "  spoken  by  a 

stutterer .         .28 

10.  Mouth   record   of    "papa"    with   an   inspiratory    "p" 

spoken  by  a  stutterer 28 

11.  Mouth  record  of  "  sleepy "  spoken  normally     .        .        .  29 

12.  Mouth  record  of  "  sleepy  "  spoken  by  a  stutterer      .        .  30 

13.  Mouth  record  of  "  stutter  "  spoken  normally    ...  30 

14.  Mouth  record  of  "  stutter  "  spoken  by  a  stutterer     .        .  31 

15.  Mouth  record  of  "  Peter  Piper's  peppers  "  spoken  by  a 

stutterer 32 

16.  Melody  plot  for  "  papa  "  spoken  normally  (Fig.  8)          .  33 

17.  Melody  plot  for  "  papa  "  spoken  by  a  stutterer  (Fig.  9)   .  34 

18.  Mouth  record  of  "  papa  "  in  a  case  of  spastic  speech        .  50 

19.  Mouth  record  of  "  papa  "  in  a  case  of  motor  aphasia        .  51 

20.  Mouth  record  of  "  papa  "  in  a  case  of  bulbar  paralysis     .  53 

21.  Scheme  to  illustrate  the  mechanism  of  stuttering    .        .  58 

xi 


Xll 


LIST   OF  ILLUSTRATIONS 


ria. 


o?. 


24. 


26. 
27. 
28. 
29. 
30. 
31. 
32. 


M. 
35. 
36. 

37. 

38. 

39. 

40. 
41. 
42. 
43. 
44. 
45. 
46. 


Notes  indicating  how  the  phrase  "  How  do  you  do?**  i& 
to  be  sung 

Line  indicating  how  the  phrase  "  How  do  you  do?  "  is  to 
be  sung  according  to  the  notes  in  Fig.  22     . 

Line  indicating  how  the  normal  voice  should  rise  and 
fall  in  speaking  the  phrase  "  How  do  you  do?"  with  a 
melody  similar  to  that  indicated  in  Fig.  21  . 

Line  indicating  the  monotony  of  the  stutterer's  voice  in 
speaking  the  phrase  "  How  do  you  do?" 

Mouth  record  showing  the  word  "  papa  '*  as  actually  sung 

Melody  plot  to  Fig.  26 

Octave  twist  in  musical  notation 

Octave  twist  indicated  by  a  line        .... 

Mouth  record  of  "  papa  "  spoken  with  the  octave  twist 

Melody  plot  to  Fig.  30 

Mouth  record  of  "  papa  "  spoken  with  an  unsuccessful 
attempt  at  the  octave  twist    .... 

Melody  plot  to  Fig.  32 

Perfect  closure  of  the  glottis      .... 

Glottis  during  a  breathy  tone    .... 

Yowel  curve  with  normal  beginning  and  ending 

Yowel  curve  with  glottal  catch  at  beginning  and  ending 

Mouth  record  of  the  stutterer's  correction  of  the  inspira- 
tory "  p"  in  Fig.  10        ...         . 


Median  section  of  the  organs  of  enunciation 
nation 

Artificial  palate 

Palatogram  for  the  vowel  "  ee  " 

Candle  flame  indicator  used  for  the  mouth 

Tambour  indicator  used  for  the  nose 

Lip  position  for  "  f  "  and  "  v  "  . 

Lip  position  for  "  w  " 

Lip  position  for  correcting  "  w  '*  into  "  v  " 


and 


pho 


PAGE 


75 


75 


76 

76 
77 
77 
78 
78 
78 
79 

79 
80 
81 
81 
82 
82 

89 

113 
114 
115 
119 
120 
122 
123 
124 


LIST  OF  ILLUSTRATIONS 


Xlll 


PIG. 

47.  Palatogram  for  forward  "  t "  and  "  d  "      . 

48.  Palatogram  for  backward  "  t "  and  "  d  "  . 

49.  Palatogram  for  "  k  "  and  "  g  "  . 

50.  Mouth  diagram  for  "  t "  and  "  d  "     . 

51.  Mouth  diagram  for  "k"  and  "  g"     . 

52.  Mouth  record  of  "  water  "  spoken  normally 

53.  Mouth  record  of  "  water  "  spoken  by  a  lisper 

54.  Palatogram  for  "  s  "  and  "  z  "    . 

55.  Palatogram  for  occluded  "  s  "  and  "  z  "     . 

56.  Mouth  diagram  for  "  s  "  and  ''  z  "     . 

57.  Mouth  diagram  for  occluded  ^'  s  "  and  "  z  " 

58.  Mouth  record  of  "  sun  "  spoken  normally 

59.  Mouth  record  of  "  sun  "  spoken  by  a  lisper 

60.  Tongue  record  for  occluded  "  s  " 

61.  Correcting  occluded  "  s  "  and  "  z  "     . 

62.  Making  the  interdental  fricative 

63.  Mouth  record  of  the  word  "  Mitchell " 

64.  Mouth  record  of  the  word  "  nutshell " 

65.  Palatogram  for  "  ch  "  and  "  j " 

66.  Mouth  diagram  for  "  ch  "  and  "  j  " 

67.  Mouth  diagram  for  "  n  "    . 

68.  Mouth  diagram  for  "  ng  " 

69.  Palatogram  for  "  sh  '* 

70.  Mouth  diagram  for  "  sh  '* 

71.  Palatogram  for  "  th  " 

72.  Mouth  diagram  for  "  th  " 

73.  Mouth  record  of  "  thin  "  spoken  normally 

74.  Mouth  record  of  "  tin  "  spoken  normally 

75.  Mouth  record  of  "  thin  "  with  occluded  "  th,"  by  a 

76.  Correcting  occluded  "  th  " 

77.  Mouth  record  of  front  rolled  "  r  "  by  an  American 

78.  Palatogram  for  English  "  r  "     . 


lisper 


PAGE 

125 

125 

125 

125 

125 

126 

126 

130 

130 

131 

131 

132 

132 

132 

133 

134 

136 

136 

137 

138 

139 

139 

140 

140 

141 

141 

142 

142 

143 

143 

144 

145 


XIV 


LIST  OF  ILLUSTRATIONS 


((  V  '» 


79.  Mouth  diagram  for 

80.  Mouth  record  of  English  "r" 

81.  Mouth  record  of  uvulia  "  r  **  by  a  Parisian 

82.  Palatogramfor"!"  .... 

83.  Mouth  diagram  for  "  1 "  . 

84.  Rod  for  pushing  the  tongue     . 

85.  Pushing  the  tongue  into  position  for  "  r  '* 

86.  Recording  the  nasal  current  and  vibrations 

87.  Nasal  record  of  "  sun  *'  spoken  normally 

88.  Nasal  record  of  "  sun  "  with  relaxed  velum 

89.  Tissue  paper  indicator 

90.  Velar  hook 

91.  Velar  hook  in  position 

92.  Mouth  record  of  " dog" 

93.  Mouth  record  of  "  dok  " 

94.  Mouth  record  of  "  dogk ' 

95.  Mouth  record  of  "  apa  "  with  the  explosion  of  "  p 

marked 

96.  Mouth  record  of  "  apa  "  with  no  explosion  of 

97.  Hemiatrophy  of  the  tongue     . 

98.  Mouth  record  of  "  so  "  spoken  normally 

99.  Mouth  record  of  "  so  "  in  neurotic  lisping 

100.  Mouth  record  of  "  silk  *'  spoken  normally 

101.  Mouth  record  of  "  silk  **  in  neurotic  lisping 

102.  Mouth  record  of  "  shoe  "  in  normal  speech 

103.  Mouth  record  of  "  shoe  "  in  neurotic  lisping 


«p» 


well 


PAGE 

145 
145 
146 
146 
146 
147 
147 
151 
152 
152 
153 
154 
155 
156 
156 
157 

158 
158 
163 
175 
175 
177 
177 
178 
179 


Plates  I,  II,  III.    Mouth  diagrams  for  typical  English  sounds. 
Plate  rV.    Palatograms  for  typical  English  sounds. 


STUTTERING  AND   LISPING 


STUTTERmG  AND  LISPING 
PART  I 

STUTTERING 
CHAPTER  I 

DESCRIPTION.      CAUSE 

As  ^^stutterers''  we  designate  individuals  show- 
ing certain  peculiarities  of  speech.  One  stutterer, 
for  example,  will  make  spasmodic  contractions  of  the 
lips,  tongue,  etc.,  whereby  a  word  like  ^' berry" 
will  be  pronounced  '^b-b-b-b-berry."  Another  will 
open  his  mouth  wide  and  produce  an  ^^a-a-a-a-" 
before  he  can  say  a  word.  Another  will  find  himself 
suddenly  unable  to  speak  at  all  at  the  beginning  or 
in  the  middle  of  something  he  wants  to  say.  Still 
others  are  quite  unable  to  speak  certain  words.  One 
young  man  could  never  speak  the  name  of  his  town 
and  was  obliged  always  to  buy  his  railway  ticket  to 
the  next  town  beyond.  One  lady  would  find  herself 
at  a  ticket  office  suddenly  speechless  and  unable  to 


2  STUTTERING  AND  LISPING 

tell  what  ticket  she  wanted  while  an  impatient  crowd 
of  commuters  gathered  behind  her. 

Stuttering  is  a  serious  detriment  to  the  person's 
welfare.  One  refined  stuttering  girl  of  sixteen  was 
studying  typewriting  and  stenography,  not  realiz- 
ing that  no  office  would  tolerate  a  secretary  who 
could  not  answer  when  suddenly  spoken  to  or  who 
could  not  use  the  telephone.  But  what  was  she  to 
do  for  a  living  ?  Even  on  the  lower  level  of  a  shop 
girl  she  would  be  impossible.  The  examiners  of 
immigrants  at  New  York  City  often  refuse  admis- 
sion to  stutterers  on  the  ground  that  they  are  liable  to 
be  unable  to  make  a  living  and  Ukely  to  become  public 
charges.  A  law  student  felt  that  on  account  of  his 
stuttering  he  must  relinquish  his  ambitions  and  con- 
fine himself  to  uncongenial  work.  At  the  best,  the 
stutterer's  social  life  is  limited  and  abnormal.  He 
often  retires  from  social  intercourse  as  much  as  pos- 
sible and  becomes  more  or  less  eccentric.  One  boy 
grew  up  in  such  isolation  that  his  oddities  made  him 
appear  feeble-minded,  although  he  was  not  mentally 
defective.  Excessive  stuttering  has  been  made  the 
.  basis  of  divorce  for  cruelty. 

To  most  people  stutterers  seem  comical.     They 


DESCRIPTION.     CAUSE  3 

are  the  butts  of  innumerable  anecdotes  in  the  news- 
papers and  on  the  stage.  The  stutterer  learns  that 
people  regard  him  as  a  kind  of  involuntary  clown  and 
that  his  family  and  friends  are  ashamed  of  him. 

Few  persons  realize  how  terrible  life  becomes  to  a 
stutterer.  A  normal  person  may  get  a  mild  idea  of 
it  by  supposing  that  every  time  before  he  speaks  he 
is  obliged  to  wink  one  eye  or  to  open  his  mouth  and 
yawn ;  the  feeling  of  embarrassment  and  shame  would 
soon  overpower  him.  A  stutterer  is  worse  off; 
every  time  he  tries  to  speak  he  is  obliged  to  make 
a  fool  of  himself  in  such  a  way  as  to  make  other 
people  want  to  laugh  at  him.  One  religious  but 
stuttering  lady  finally  demanded  to  be  '^  cured  or 
chloroformed."  One  boy  often  threw  himself  on 
the  floor,  begging  his  mother  to  tell  him  how  to  die. 
Another  boy  asked  for  a  letter  to  his  father,  telling 
him  to  keep  the  other  children  from  laughing  at 
him.  Many  stutterers  become  so  sensitive  that 
they  imagine  everybody  is  constantly  making  fun 
of  them.  The  life  of  a  stutterer  is  usually  so  full  of 
sorrow  that  it  can  hardly  be  said  to  be  worth  living. 

At  school  the  child  is  tormented  by  his  fellow 
mates.     He  is  usually  a  trial  to  the   busy  teacher 


4  STUTTERING  AND   LISPING 

and  a  hindrance  to  the  progress  of  the  class.  He  is 
often  excused  from  oral  recitation,  but  just  as  often 
the  teacher  constantly  corrects  him  or  ridicules 
him.  Sometimes  it  happens  that  the  child  has  a 
cramp  that  keeps  him  from  starting  an  answer  for  a 
moment,  but  does  not  show  itself  otherwise,  such  a 
stutterer  prefers  to  be  thought  lazy  or  stupid  rather 
than  reveal  the  true  nature  of  his  trouble. 

Even  at  home  the  stutterer  is  misunderstood  and 
often  tortured  from  the  best  motives.  He  is  fre- 
quently reproved  or  scolded  as  an  inattentive  or 
bad  boy  because  he  ''could  speak  properly  if  he 
would  only  try."  Many  a  parent  is  often  sure  that 
this  is  so  because  the  child  will  speak  properly  when 
reminded  to  do  so.  The  truth  is  that  no  human 
being  can  always  think  of  how  he  is  to  speak  before 
he  speaks ;  the  stutterer  simply  cannot  stop  stutter- 
ing of  his  own  accord. 

Stuttering  is,  indeed,  a  serious  disease.  It  is 
not  as  undesirable  as  mania  or  cancer,  but  most 
people  would  prefer  to  have  typhoid  or  pneumonia 
for  the  simple  reason  that  with  these  diseases  a  per- 
son either  dies  or  recovers,  whereas  stuttering  is  a 
lifelong  torture. 


DESCRIPTION.    CAUSE  5 

A   very   great   injustice   to   tlie  stutterer  is  the 
widely  spread  notion  that  stuttering  is  a  bad  habit 
which  is  to  be  corrected   by  reproof,   scolding  and 
punishment.      The  treatment  is  supposed  to   con- 
sist in  a  kind  of  schooling,  the  result  depending  on 
the  diligence    of    the   pupil.     Lack  of   progress    is 
attributed    to    inattention    or    laziness.     Parents, 
friends,    and    teachers    are    always    alert    to    test 
the  patient's  progress.     Of  course,  all  this  simply 
makes  the  stutterer  worse,  turns  a  mild  case  into  a 
severe  one,  and  drives  many  a  sufferer  to  despair. 
Stuttering  is  a  disease ;    it  can  be  properly  treated 
only  on  the  principles  of  any  other  disease.     Just  as 
with  all  other  diseases,  some  cases  get  well  spon- 
taneously and  some  get  well  no  matter  how  they  are 
treated ;   yet  so  few  recover  permanently  under  the 
treatments  in  vogue    that    there    is    a  widespread 
opmion  that  stuttering  is  incurable. 

The  most  frequent  cause  of  stuttering  is  a  nervous 
shock.  Ghosts  and  other  practical  jokes,  and,  with 
very  small  children,  such  terrifying  experiences  as 
are  found  at  amusement  resorts  (scenic  railways, 
fire  scenes,  etc.)  are  often  the  causes  of  fright  from' 
which  the  child  never  recovers.     Severe  falls  are  just 


6  STUTTERING  AND   LISPING 

as  often  the  sources  of  the  mental  shock.  Surgi- 
cal operations  (for  cataract,  adenoids,  etc.)  are 
occasionally  the  sources  of  stuttering.  The  cause  of 
stuttering  in  all  these  cases  is  evidently  the  intense 
fear  involved  in  the  shock.  In  some  cases  the  fear 
has  developed  gradually.  A  boy  of  twelve  relates 
that  at  the  age  of  seven,  on  several  occasions  in  the 
daylight  he  thought  he  heard  footsteps  of  some  one 
following  him  in  the  hall,  whereas  the  noise  was  of 
his  own  footsteps ;  thereafter  he  began  to  stutter. 
He  is  still  afraid  to  walk  in  the  dark,  to  be  alone  or  to 
go  to  sleep  in  the  dark.  A  young  man  of  seventeen 
relates  that  he  began  to  stutter  in  reading  at  seven 
years  because  he  knew  that  he  would  make  mistakes 
before  the  class  and  become  nervous  about  it. 

Most  of  the  stutterers  from  shock  show  a  general 
condition  of  nervous  excitability  in  which  the  pre- 
dominant element  is  an  abnormal  state  of  expectancy 
toward  persons  and  events.  The  patient  is  often 
on  the  alert  for  what  is  going  to  happen.  He  watches 
other  people  and  replies  before  they  half  finish  their 
remarks ;  or  he  is  timid  to  such  a  degree  that  conver- 
sation is  painful.  The  same  condition  of  general  over- 
anxiety  I  have  found  in  patients  who  do  not  stutter. 


DESCRFPTION.    CAUSE  7 

It  is  a  typical  psychoneurosis,  that  may,  perhaps,  be 
appropriately  called  the  ^'general  anxiety  neurosis." 
In  addition  to  the  kinds  of  nervous  shock  mentioned 
above,  it  is  possible  that  the  cause  of  the  general 
anxiety  neurosis  may  lie  in  shocks  of  various  kinds 
occurring  in  infancy  and  childhood.  This  ^'general 
anxiety  neurosis"  differs  from  the  anxiety  neurosis 
of  Freud  in  several  ways.  In  the  former  the  anxiety 
(or  fear)  is  present  at  all  times  ;  it  is  ready  to  attach 
itself  to  any  thought  or  occurrence  for  which  a  fairly 
valid  reason  can  be  found ;  the  patient  knows  that  he 
is  overanxious,  but  his  anxiety  always  seems  fully 
justified  at  the  moment.  In  the  latter  the  anxiety 
attaches  itself  to  one  particular  thing,  for  example, 
the  patient  cannot  cross  an  open  space  because  he 
is  afraid  to  do  so;  although  the  fear  is  irresistible, 
the  patient  usually  realizes  fully  that  it  is  absurd. 

A.  very  frequent  cause  of  stuttering  is  mental 
contagion  by  intentional  or  unintentional  imitation. 
A  boy  thinks  it  fun  to  mock  a  stutterer,  and  ulti- 
mately finds  that  he  himself  cannot  stop  stuttering. 
A  stuttering  parent  nearly  always  has  one  or  more 
stuttering  children.  Even  when  the  parent  had 
stopped    stuttering    in    youth,    there    are   usually 


8  STUTTERING  AND   LISPING 

enough  traces  left  in  his  speech  {e.g.  hard  voice)  to 
start  the  child  stuttering.  Stuttering  has  been 
known  to  develop  in  a  child  from  playing  with  a 
deaf-mute  who  talked  with  difficulty. 

Stuttering  frequently  appears  after  whooping 
cough,  also  after  scarlet  fever,  measles,  influenza, 
intestinal  troubles,  scrofula,  rickets,  etc.  The 
cause  seems  to  lie  in  the  condition  of  exhaustion. 

One  of  my  cases  showed  symptoms  of  spastic 
infantile  paralysis  (spasticity  of  the  legs,  weakness 
and  athetosis  of  the  hands,  weakness  of  the  muscles 
of  speech)  with  history  of  difficult  birth.  The 
difficulty  in  using  the  muscles  of  speech  may  be 
assigned  as  the  cause  of  the  stuttering. 

A  neuropathic  disposition  or  a  condition  of  nerv- 
ous exhaustion  is  present  in  nearly  all  cases  of 
stuttering. 

The  first  suggestion  for  prophylaxis  is  that  parents 
and  nurses  are  to  avoid  stories  and  scenes  that 
frighten  children.  Nervous  children  should  receive 
tonic  treatment,  especially  open-air  life.  If  one  child 
in  a  family  begins  to  stutter,  he  should  be  cured 
immediately  in  order  to  save  the  others.  A  stutter- 
ing child  in  school  is  a  danger  to  his  fellows. 


DESCRIPTION.    CAUSE  9 

The  statistics  show  from  1  to  2  per  cent  of  stut- 
terers among  school  children.  A  smaller  percentage 
in  the  lower  classes  becomes  trebled  in  the  higher 
ones.  Marked  increases  are  found  at  the  periods 
of  second  dentition  and  puberty.  The  relative  fre- 
quency among  boys  and  girls  ranges  from  2 : 1  to 
9:1. 


CHAPTER  II 

SYMPTOMS,  FORMS,  NATURE 

The  most  striking  symptoms  are  cramps  or  spasms 
of  the  muscles  connected  with  speech. 

Abdominal  cramps  are  nearly  always  present.  The 
entire  abdomen  may  suddenly  become  rigid,  or  it 
may  make  irregular  contractions.  In  one  case  the 
wall  just  over  the  navel  was  drawn  into  a  deep 
cuplike  cavity.  The  diaphragm,  as  seen  by  the 
X-rays,  may  be  suddenly  fixed  or  may  move  down- 
ward in  spasms.  The  spasms  sometimes  propel  the 
abdominal  wall  outward  in  jerks.  Often  both 
abdominal  muscles  and  diaphragm  will  become 
perfectly  rigid  and  immovable.  These  contrac- 
tions produce  irregular  interruptions  or  expulsions 
of  the  breath  instead  of  the  steady  current  necessary 
for  proper  speech,  or  they  give  no  breath  at  all  and 
render  the  patient  speechless.  One  patient  of  mine 
often  became  suddenly  speechless  in  this  way  for 

ten  to  fifteen  seconds  at  a  time.     A  frequent  phe- 

10 


SYMPTOMS,   FORMS,  NATURE  U 

nomenon  is  the  expulsion  of  the  breath  just  before 
speaking.  The  most  frequent  case  is  that  of  con- 
tinual irregularities  of  breathing  during  actual 
speech. 

Laryngeal  cramps  are  a  never-failing  symptom  of 
stuttering.  The  muscles  in  and  around  the  larynx 
become  tense  and  fixed.  The  tone  from  the  larynx 
is  monotonous,  hard,  and  often  husky.  It  is  not  un- 
usual to  find  a  patient  who  never  has  any  symptom 
of  stuttering  in  the  presence  of  the  physician  except 
the  monotonous  laryngeal  tone.  I  have  never  seen 
a  stutterer  without  this  symptom. 

Cramps  and  spasms  of  the  muscles  of  enuncia- 
tion are  the  ones  most  apparent  to  the  observer. 
The  lips  may  be  pressed  tightly  together  for  a  short 
or  a  long  time  when  the  patient  tries  to  say  ^^p^^ 
or  ^^b."  In  other  cases  they  will  open  and  shut, 
producing  a  series  of  ^^p"s  or  "b"s  instead  of  one. 
The  tongue  may  be  pressed  so  tightly  against  the 
palate  that  the  ^'  t"  or  the  "d"  is  two,  three,  or  ten 
times  too  long.  All  the  sounds  may  be  similarly 
affected. 

Less  frequent  but  more  striking  are  the  contrac- 
tions of  muscles  not  ordinarily  used  in  speech.     One 


12  STUTTERING  AND   LISPING 

patient  will  twist  his  head  whenever  he  stutters 
badly,  another  will  screw  up  one  eye,  another  will  con- 
tort his  whole  body,  etc.  One  patient  had  ^' pains 
that  did  not  hurt"  in  her  legs  and  arms  while  speak- 
ing. One  boy  of  seven  made  horrible  grimaces  and 
stuck  his  tongue  like  a  thick  stick  far  out  between 
his  lips.  One  girl  of  twenty- two  would  spend  one 
to  two  minutes  in  grunting  like  a  pig  and  whimper- 
ing like  a  dog  after  which  she  would  say  the  word 
or  sentence  with  ease. 

All  the  muscles  involved  in  speech  are  brought 
into  a  condition  of  over-tension  or  ^^hypertonicity" 
whenever  the  stutterer  begins  to  speak,  although 
there  may  be  no  visible  cramps  or  spasms  or  any 
stuttering  in  the  popular  sense.  Hypertonicity  is 
thus  a  cardinal  system  of  stuttering.^  The  hyper- 
tonicity is  psychic  (cerebral)  and  not  spinal ;  it 
appears  only  when  the  person  intends  to  speak; 
the  reflexes  are  not  exaggerated. 

The  trained  ear  readily  detects  the  hard  tone  of 
the  voice  which  results  from  laryngeal  hypertonicity. 
The  expert  can  thus  tell  from  the  first  sound  that 

^Scripture,  "Treatment  of  Hyperphonia,"  Medical  Record, 
March  21,  1908. 


SYMPTOMS,  FORMS,  NATURE         13 

the  patient  makes  whether  he  has  started  his  sentence 
correctly  or  has  begun  with  the  stuttering  tone  that 
will  cause  him  to  stumble  before  he  finishes. 

Another  kind  of  symptom  occurs  in  the  ^'er," 
^^well,"  etc.,  that  the  stutterer  uses  to  get  started. 
Sometimes  this  ^'starter"  is  an  inarticulate  but 
complicated  grunt.  Sometimes  the  starter  is  re- 
peated several  times ;  one  young  lady  would  regu- 
larly repeat  ''why"  ten  to  fifteen  times  before  she 
could  get  out  the  first  word  of  what  she  wanted  to 
say,  and  even  then  she  sometimes  failed  and  had  to 
begin  over  again.  Often  the  patient  has  to  make 
severe  contortions  of  the  face  or  the  head  or  the 
body  before  he  can  begin. 

An  almost  constant  symptom  is  excessive  rapidity 
of  speech.  In  some  cases  this  is  to  be  attributed  to 
the  desire  of  the  stutterer  to  get  his  words  out  before 
he  is  caught  or  before  any  one  can  interrupt  him.  In 
most  cases  it  is  the  expression  of  nervous  anxiety. 

A  never  failing  symptom  is  the  patient's  lack  of 
confidence  in  his  ability  to  speak  correctly.  In 
some  cases  the  mere  thought  ''Will  I  be  able  to  say 
that  word?"  is  sufficient  to  make  it  absolutely 
impossible  for  the  person  to  say  it.     The  stutterer 


14  STUTTERING  AND   LISPING 

always  lives  with  the  fear  that  his  speech  may  ''go 
back  on  him."  Many  a  one  is  always  thinking  a 
few  words  ahead  of  what  he  is  saying,  being  on  the 
lookout  for  some  word  he  thinks  he  cannot  say. 
When  such  a  word  is  coming,  he  avoids  it  by  select- 
ing another  that  will  serve  just  as  well.  One  patient 
practically  passed  his  life  in  always  avoiding  words ; 
this  mental  work,  being  added  to  that  of  a  normal 
man,  kept  him  in  a  condition  of  nervous  prostration. 

The  fear  of  being  ridiculous  is  nearly  always 
present.  The  person  does  not  want  to  ''make  a  fool 
of  himself."  He  therefore  avoids  reciting  in  school, 
he  refuses  invitations  to  social  affairs,  he  would 
rather  live  with  his  father's  employees  in  a  mine  than 
go  to  college,  he  shuts  himself  up  with  a  servant  and 
becomes  a  queer-mannered  hermit,  etc. 

A  condition  of  mental  flurry  is  usually  present. 
When  the  patient  starts  to  speak,  he  becomes  partly 
dazed  by  his  emotion  and  does  not  know  exactly 
what  he  wants  to  say.  This  condition  may  be  pres- 
ent even  when  he  does  not  stutter;  in  trying  to 
answer  a  question,  for  example,  he  cannot  make  up 
his  mind  just  what  he  wishes  to  say.  Closely  con- 
nected with  this  is  a  habit  of  hesitating  in  thought 


SYMPTOMS,    FORMS,   NATURE  15 

that  sometimes  arises.  The  mental  flurry  perhaps 
explains  why  some  stutterers  have  most  trouble 
whenever  they  are  jocular.  In  some  cases  they 
stutter  only  when  jocular. 

With  very  rare  exceptions  the  stutterer  does  not 
stutter  when  he  knows  no  one  can  hear  what  he  says. 
Almost  as  rare  are  the  cases  where  he  stutters  in 
singing  or  in  whispering. 

'  The  embarrassment  and  sad  experiences  of  the 
stutterer  often  lead  to  an  abnormal  mental  condi- 
tion. The  patient  is  nervous,  shy,  easily  embar- 
rassed, retiring,  odd  in  his  ways,  sad.,  etc.  In  some 
cases  the  change  does  not  go  beyond  an  increased 
sensitiveness.  Many  stutterers,  especially  young 
women  and  schoolboys,  acquire  a  permanent  facial 
expression  that  is  typical  of  the  profoundest  sadness. 
The  thought  of  suicide  is  frequent. 

Three  forms  or  stages  of  stuttering  may  be  dis- 
tinguished. 

The  simplest  form  of  stuttering  is  that  of  ^^pure 
habit."  Such  a  case  occurs  rather  frequently  where 
a  younger  child  unintentionally  copies  the  stutter- 
ing of  an  older  one.  If  the  stuttering  does  not  go 
beyond  the  stage  of  pure  habit,  the  younger  child 


16  STUTTERING  AND   LISPING 

drops  his  stuttering   involuntarily  when  the    older 
one  is  removed  or  cured. 

The  habit  stage  is  often  initiated  by  shock  or 
exhaustion.  The  person  finds  himself  making  inac- 
curate movements  in  speaking,  and  speaking  a  word 
or  words  indistinctly.  On  account  of  the  excessive 
nervous  irritability  in  these  conditions,  he  feels  that 
he  cannot  permit  himself  to  speak  in  an  improper 
fashion,  so  he  instinctively  tries  to  correct  the 
inaccurate  movements  by  an  extra  effort  at  distinct- 
ness. Such  an  effort  produces  excessive  muscular 
tension;  his  consonants,  like  ^^p,"  '^b,"  ^^f,"  ^'d,'^ 
etc.,  are  too  hard  and  long.  This  in  turn  impresses 
itself  on  the  memory,  so  that  when  he  again  makes 
the  same  sounds  he  naturally  makes  excessive 
muscular  movements.  The  excessive  tension  readily 
becomes  repetition,  so  that,  for  example,  instead  of  a 
long  '^p"  he  says  ^'p-p-p/'  etc.  Such  was  the  case 
with  a  patient  two  and  a  quarter  years  old  who 
stuttered  constantly  by  reduplicating  the  conso- 
nants, saying,  for  example,  ^^strawb-b-b-b-berries" 
and  showing  monotony  of  the  laryngeal  tone  and  the 
usual  symptoms.  After  a  few  days  of  correction 
whereby  the  stuttered  words  were  repeated  correctly 


SYMPTOMS,   FORMS,   NATURE  17 

with  melodious  intonation  by  the  father  each  time 
after  her,  she  ceased  to  stutter. 

A  patient  two  years  old,  when  seen  three  weeks 
after  the  stuttering  began,  could  be  induced  to  speak 
only  with  great  difficulty  on  account  of  the  feeling  of 
shame  that  was  evidently  present.  When  she  spoke, 
it  was  in  an  abnormally  low  tone,  with  stumbling  and 
repetition  of  consonants.  There  was  no  neuropathic 
history,  but  a  previous  exhausting  illness.  Being 
told  to  sing  what  she  wanted  to  say,  she  stopped 
stuttering  and  spoke  naturally  after  a  few  days.  In 
both  these  cases  we  may  assume  that  the  exhausted 
nervous  system  led  to  inaccurate  movements.  These 
produced  a  feeling  of  uncertainty  and  insecurity, 
which  in  turn  aggravated  the  inaccuracy  and  led  to 
excessive  cramplike  efforts.  Every  incorrectness 
of  action  increased  the  uncertainty  of  feeling,  and 
vice  versa.  The  parent's  correction  soon  made  the 
child  feel  that  it  was  doing  something  reprehensible ; 
this  produced  not  only  embarrassment,  but  also  still 
greater  inaccuracy  and  uncertainty. 

The  stuttering  habit  may  be  initiated  by  embar- 
rassment. It  sometimes  occurs  that  a  lisping  child 
becomes  so  nervous  over  his  defect  and  over  the  way 


18  STUTTERING  AND   LISPING 

other  people  treat  him  that  he  begins  to  stutter. 
The  hsping  in  such  cases  is  usually  due  to  tongue- 
tie;  this  is  the  only  case  in  which  stuttering  is 
connected  with  tongue-tie. 

Quite  a  few  cases  occur  where  the  stuttering  habit 
is  begun  at  three  or  four  years  of  age  with  no  history 
of  shock,  exhaustion,  or  imitation.  It  is  possible  that 
the  child's  awkwardness  in  using  his  speech  organs 
leads  him  into  blunders  over  which  he  becomes 
nervous. 

The  stutterer  nearly  always  goes  beyond  the 
habit  stage.  People  laugh  at  him,  mock  him,  scold 
him,  threaten  him  with  punishments,  or  whip  him. 
Usually  he  is  obliged  to  repeat  words  he  stumbles  on. 
He  is  made  to  go  through  reading  and  speaking 
exercises.  Extra  hard  words  are  given  him  to 
practice  on.  Speaking  becomes  a  torture  for  him. 
A  new  element,  the  ^'fear  of  displeasing  and  of 
appearing  ridiculous,"  produces  the  ^^ fright  stage." 
The  stuttering  is  now  a  distinct  psychoneurosis 
that  may  have  the  most  far-reaching  consequences. 

If  the  question  is  asked  of  a  patient  in  the  fright 
stage,  '^Why  do  you  stutter?"  he  will  answer,  '' Be- 
cause I  am  afraid  that  I  will  stutter."     Many  a  one 


SYMPTOMS,   FORMS,   NATURE  19 

will  say  that  if  he  could  only  forget  that  he  had 
stuttered,  he  would  never  stutter  again.  When  the 
stutterer  wishes  to  speak,  the  thought  of  his  pre- 
vious failures  occurs  to  him  and  he  fears  or  knows 
that  he  will  appear  ridiculous  to  those  before  whom 
he  is  speaking.  This  element  disturbs  his  mental 
condition.  He  is  seized  with  a  violent  emotion  that 
may  be  described  as  stage  fright  before  a  single 
person.  Embarrassment,  shame,  fear,  etc.,  express 
themselves  in  his  face  and  often  disturb  his  mental 
actions  so  that  he  cannot  think  clearly.  The  emo- 
tion niay  make  him  absolutely  speechless,  as  in  the 
case  of  many  patients  who  cannot  say  a  word  when 
introduced  to  strangers.  Or  it  may  make  him 
stumble  over  his  words ;  naturally  he  stumbles  in 
the  way  he  has  learned  to  stumble,  namely,  with 
stuttering  cramps. 

The  disturbance  of  mental  action  during  the  fright 
stage  may  produce  a  kind  of  intellectual  paralysis. 
One  patient  was  often  unable  to  answer  a  question, 
not  because  he  was  afraid  of  stuttering,  but  because 
the  requirement  of  answering  actually  paralyzed  his 
mind  so  that  he  could  not  think  of  the  answer.  This 
habit  had  become  so  thoroughly  formed  in  another 


20  STUTTERING  AND  LISPING 

patient  that  any  excitement  might  render  him 
unable  to  think ;  on  the  football  field,  where  the 
system  of  signals  required  him  to  add  numbers,  he 
would,  upon  hearing  the  signals  ''six  and  four," 
which  had  to  be  added  together,  have  to  ask  his 
neighbor  how  much  they  amounted  to.  One  stutterer 
explained  the  mental  paralysis  when  asked  to  give 
his  name  or  any  exact  information  as  resulting  from 
the  fact  that  he  is  overwhelmed  by  having  some 
one  depend  on  him  for  information  that  he  alone 
can  give. 

A  third  stage  occurs  not  infrequently.  The 
stutterer  is  no  longer  embarrassed  by  his  defect.  It 
is  obnoxious  to  him,  and  he  would  like  to  be  rid  of  it, 
but  the  fright  has  disappeared.  This  may  be  termed 
the  ''stage  of  indifference."  It  is  usually  found  in 
older  patients ;  they  stutter  because  the  habit  is 
firmly  fixed  and  not  because  they  are  embarrassed. 

In  many  cases  stuttering  seems  to  be  associated 
with  a  peculiarity  of  character.  This  cannot  be 
attributed  entirely  to  the  presence  of  the  stuttering. 
In  one  case  in  my  experience  the  child  had  previously 
developed  a  condition  of  nervousness  which  had 
become  very  extreme  on  account  of  lack  of  training 


SYMPTOMS,   FORMS,   NATURE 


21 


in  self-control.  The  stuttering  habit,  engrafted 
on  this,  became  very  violent.  In  another  case  the 
stuttering  was  associated  with  slowness  of  thought ; 


Fig.  1.  —  Recording  the  movements  of  breathing  by  the  graphic  method. 
Two  metal  cups  with  rubber  tops  are  fixed  over  the  chest  by  a 
band.  Expansion  over  the  chest  draws  air  into  the  cups.  They 
are  connected  by  a  rubber  tube  to  a  small  recording  tambour. 
This  is  a  metal  cup  with  a  rubber  top  which  moves  a  light  recording 
lever.  A  line  drawn  by  this  lever  on  a  smoked  surface  moved  by 
clockwork  gives  a  record  of  the  breathing  movements.  The  record- 
ing arrangements  can  be  attached  to  the  abdomen  also. 

sometimes  the  hesitation  in  speech  seemed  to  be  a 
cloak  for  hesitation  in  thought.  Several  previous 
attempts  at  cure  had  failed  to  be  permanent  on 
account  of    lack  of    moral  backbone.     In  another 


22  STUTTERING  AND   LISPING 

case  the  stuttering  had  appeared  in  a  small  boy 
who  had  never  been  taught  any  self-control.  Very 
often  stutterers  are  shy  and  bashful  to  an  extent 
that  can  hardly  be  justified  by  their  painful  speech 
experiences. 

The  stutterer's  speech  movements  may  be  accu- 
rately recorded  and  studied  by  the  methods  of 
experimental  phonetics. 

The  movements  of  the  chest  during  speech  may 
be  recorded  by  the  apparatus  shown  in  Fig.  1. 

The  '^ pneumograph"  shown  in  the  figure  consists 
of  two  metal  cups  with  tops  of  soft  rubber.  A  tape 
runs  around  the  body  from  one  rubber  top  to  the 
other.  As  the  chest  expands,  the  rubber  tops  are 
pulled  outward.  This  draws  air  inward  through 
the  tubes  which  open  into  the  metal  cups.  As  the 
chest  falls,  the  air  passes  out  again. 

The  ^^ recording  tambour"  is  a  metal  cup  with 
a  rubber  top.  It  is  connected  with  the  pneumo- 
graph by  a  rubber  tube.  As  the  air  is  drawn  into 
or  expelled  from  the  pneumograph,  it  passes  out  of, 
or  into,  the  recording  tambour  and  makes  the  rubber 
top  bulge  inward  or  outward.  A  lever  is  arranged 
to  indicate  the  movements  of  the  rubber  top. 


SYMPTOMS,  FORMS,  NATURE 


23 


The  registration  occurs  on  a  ^^ recording  drum'' 
consisting  of  a  metal  cylinder  revolved  by  clockwork. 


J 

A 

- 

^^-^ 

NurwdJ  Bf calks 

M        111 

\\\ 

ni 

mayiiarcl 

N 

Fig.  2.  —  Breath  record  during  stuttering. 

Around   the   cylinder   a   sheet   of   paper   has   been 


Fig.  3.  — Recording  the  pressure  of  the  lips  by  the  graphic  method. 

A  small  rubber  bulb  is  placed  between  the  lips  and  is  attached  to 
the  recording  tambour. 

stretched  and  smoked  over  a  flame.     The  point  of 
the  lever  of  the  recording  tambour  is  adjusted  to 


24 


STUTTERING  AND   LISPING 


Fig.  4.  —  Lip  record  of  a  stutterer's  attempt  to  say  the  first  letter  in 
the  word  "Peter." 

Instead  of  a  single  pressure  the  stutterer  makes  repeated  con- 
tractions. 

touch  the  paper ;   it  draws  a  white  Hne  in  the  soot. 
The  paper  is  afterwards  removed  and  the  record  is 

fixed  in  shellac  varnish. 

To  record  the  breath- 
ing movements  the  pneu- 
mograph is  hung  over  the 
chest  or  the  abdomen  by 
a  tape  around  the  neck. 
The  record  reproduced  in 
Fig.  2  is  from  a  woman 
whose  abdomen  made 
violent  movements  out- 
ward during  certain  con- 
sonants.      The     records 

Fig.  5.  —  Recording  the  movements 

of  the  tongue.  show  the  movemeuts  for 

A  small  rubber  bulb  is  placed 

in  front  of  or  on  the  tongue  and    Ordinary    breathing    and 

is   connected  to  the   recording 

tambour.  the    spasms   during    the 


attempt  to  say    m. 


SYMPTOMS,   FORMS,    NATURE  25 

The  cramps  of  the^  lips  may  bo  recorded  ])y  inserting 
between  them  a  small  rubber  bulb  (Fig.  3)  and  eon- 


FiG.  6.  —  Record  of  a  stutterer's  cramps  of  the  tongue  in  attempting  to 
say  "Tommy." 

necting  it  to  a  recording  tambour  as  described 
above.  Pressure  of  the  lips  makes  the  Hne  rise.  The 
record  of  the  movement  of  the  lips  in  an  attempt 
of  a  stutterer  to  say  '^ Peter"  is  given  in  Fig.  4.  In 
spite  of  the  long  series  of  convulsive  movements  the 
patient  could  not  get  beyond  the  letter  '^p." 

The  cramps  of  the  point  of  the  tongue  may  be 
recorded  by  inserting  a  similar  bulb  behind  the 
teeth  so  that  the  tip  of  the  tongue  rests  against  it 
(Fig.  5) ;  pressure  of  the  tongue  makes  the  line  rise. 
The  result  of  an  effort  to  say  ^' Tommy"  is  given  in 
Fig.  6.  There  is  first  a  violent  spasm  of  the  tongue 
and  then  a  series  of  smaller  ones. 

Most  interesting  records  are  obtained  by  a  mouth 
recorder.     A  funnel  of  rubber  (the  top  of  a  large 


26 


STUTTERING  AND   LISPING 


stomach  tube)  is  held  over  the  mouth ;  it  is  connected 
to  a  very  small  and  delicate  registering  tambour. 
The  entire  arrangement  is  shown  in  Fig.  7. 

A  record  of  the  word  "papa  "  in  normal  speech  is 
shown  in  Fig.  8.     The  straight  line  at  the  start  cor- 


FiG.  7.  —  Recording  the  mouth  current. 

The  changes  in  air  pressure  and  the  vibrations  of  the  voice  pass 
to  a  very  small  recording  tambour  and  are  registered  on  the  smoked 
surface. 

responds  to  the  time  during  which  the  Hps  were  closed 
for  the  ''  p  "  —  the  "  occlusion."  The  sudden  rise  of 
the  line  is  the  result  of  the  puff  of  air  —  the  "  explo- 
sion "  —  that  issued  from  the  mouth  as  the  lips  were 
opened  at  the  end  of  the  ''p."     The  explosion  of  the 


SYMPTOMS,    FORMS,   NATURE  27 

*'p  "  shows  two  large  vibrations.  This  is  due  to  its 
suddenness,  whereby  the  recording  lever  receives 
something  like  a  sharp  blow,  and  vibrates  twice  in- 
stead of  once.  The  small  vibrations  that  follow  are 
a  record  of  the  first  vowel,  each  vibration  correspond- 


FiG.  8.  —  Mouth  record  of  "papa"  spoken  normally. 

It  begins  with  a  straight  line  because  the  lips  are  closed  to  produce 
the  letter  "p,"  and  no  air  can  issue  from  the  mouth ;  this  portion  of 
"p"  is  called  the  "occlusion."  The  sudden  rise  of  the  line  shows 
that  a  sharp  puff  of  air  or  "explosion"  came  from  the  mouth  as  the 
lips  were  opened  ;  the  extra  wave  in  this  explosion  is  due  to  the  vi- 
brations of  the  lever,  resulting  from  the  sharp  explosion.  The  small 
waves  record  the  vibrations  of  the  voice  for  the  vowel  "a."  They 
are  suddenly  cut  short  by  a  descent  of  the  line ;  this  is  the  result  of 
the  closing  of  the  lips  for  the  second  "p."  The  extra  wave  results 
from  the  suddenness  of  this  closure.  The  occlusion  is  followed  by 
an  explosion.     The  word  ends  with  the  vibrations  of  the  final  vowel. 

ing  to  one  vibration  of  the  vocal  cords.  The  vibra- 
tions end  by  a  sudden  fall  of  the  line  as  the  hps  are 
again  closed  for  the  second  ''p."  The  record  of  the 
explosion  for  this  ''p  "  is  similar  to  that  for  the  first 
one.  The  word  closes  with  the  vibrations  of  the  final 
vowel. 

A  record  of  the  word  "  papa  "  spoken  by  a  stutterer 
(Fig.  9)  shows  a  very  long  occlusion  for  the  first  "  p," 
followed  by  a  tremendously  long  blast  of  air,  corre- 


28 


STUTTERING  AND   LISPING 


sponding  to  the  explosion  of  the  ^^  p."     A  slow  fall  of 
the  line  after  the  first  vowel  shows  that  the  lips  were 


Fig.  9. —  Mouth  record  of  "papa"  with  blowy  "  p"  's  spoke  by  a  stut- 
terer. 

The  initial  "  p  "  has  a  very  long  occlusion,  followed  by  a  long  and 
strong  blast  of  air.  The  second  "p"  is  an  incomplete  occlusion  fol- 
lowed by  a  blast  of  air.  Comparison  with  Fig.  8  shows  clearly  how 
the  stutterer's  enunciation  differed  from  the  normal  one. 

closed  gradually  and  not  suddenly  for   the   second 
''p."     This  ^^  p  "  also  has  a  blowy  explosion. 

A  record  of  the  word  '^papa"  spoken  by  another 
stutterer  is  given  in  Fig.  10.     The  record  shows  that 


Fig.  10.  —  Mouth  record  of  "papa"  -wdth  an  inspiratory  "p"  spoken 
by  a  stutterer. 

The  sudden  descent  of  the  line  shows  that  the  stutterer  drew  in 
his  breath  to  make  the  "  p  "  instead  of  closing  his  lips.  The  vowel 
vibrations  follow  as  usual. 

instead  of  closing  his  lips  and  then  opening  them  for 
the  initial  '^  p/'  he  drew  in  his  breath  for  a  moment 
and  then  closed  his  lips,  thus  making  an  inspiration 


SYMPTOMS,    FORMS,   NATURE  29 

and  an  occlusion  instead  of  an  occlusion  and  an  ex- 
plosion. 

A  record  of  the  word  ''  sleepy  "  spoken  normally  is 
shown  in  Fig.  11.  There  is  a  gradual  rise  of  the  line 
as  the  air  issues  from  the  mouth  during  ''s."  This 
falls  rather  suddenly  as  the  tongue  changes  from  the 


Fig.  11.  —  Mouth  record  of  "  sleepy"  spoken  normally. 

The  gradual  rise  of  the  line  registers  the  rush  of  air  during  the 
second  "s."  The  small  waves  record  the  vibrations  of  the  voice 
during  "1"  and  "ee."  The  occlusion  and  the  explosion  for  "p" 
and  also  the  vibrations  for  the  final  vowel  are  similar  to  those  in 
Fig.  8. 

^'  s  "  position  to  that  for  the  '4."  There  is  a  second 
rise  with  faint  vibrations  for  the  ''1" ;  these  persist 
as  the  line  continues  to  fall.  The  rather  long  ''1" 
includes  the  vibrations  along  the  horizontal  Une. 
Suddenly  the  Hne  rises  for  the  vibrations  of  "ee/'  as 
the  tongue  moves  from  the  "  l"  position  to  the  more 
open  one  for  '^  ee.''  It  is  interesting  to  note  that  the 
"  I "  is  so  much  longer  than  the  ''  ee."  The  line  sud- 
denly falls  as  the  lips  are  closed  for  the  ''  p  "  ;  it  sud- 
denly rises  as  they  are  opened  with  a  kind  of  explo- 
sion.    The  final  vowel  is  quite  long. 


30  STUTTERING  AND   LISPING 

In  a  record  (Fig.  12)  of  the  word  ^'sleepy"  by  a 
stutterer  the  sinking  of  the  Hne  shows  an  initial  gasp 


Fig.  12.  —  Mouth  record  of  "sleepy"  spoken  by  a  stutterer. 

There  is  a  gasp  before  the  "s."  For  the  "p"  there  is  no  complete 
closing  of  the  lips  and  no  explosion.  The  small  vibrations  during 
the  "p"  show  that  the  larynx  continued  to  vibrate  instead  of  stop- 
ping. 

followed  by  a  rush  of  air  for  ^'s. "     Thereafter  come 
the  small  vibrations  indicating  the  semivowel  "1" 


Fig.  13.  —  Mouth  record  of  *'  stutter  "  spoken  normally. 

There  is  first  a  rush  of  air  for  the  "s,"  then  a  sudden  fall  as  the 
breath  is  cut  off  by  the  tongue  in  producing  the  occlusion  of  the  "  t." 
The  sharp  rise  of  the  line  registers  the  explosion  of  the  "t."  The 
small  vibrations  belong  to  the  vowel  "  u. "  The  closure  for  the  second 
"t"  ("tt")  and  the  explosion  are  similar  to  those  of  the  first.  The 
final  vibrations  belong  to  the  vowel  "er." 

and  the  vowel  ^  ^  ee. "  A  normal ' '  p  "  would  be  formed 
by  cutting  off  the  breath  at  the  lips  for  a  moment. 
In  Fig.  12,  however,  there  is  no  straight  line  for  the 


SYMPTOMS,    FORMS,   NATURE  31 


((■^  " 


p"  ;  that  is,  the  stutterer's  Ups  were  not  completely 
closed.  Naturally  there  is  no  sudden  rush  of  air  at 
the  end  of  the  ^^p."  The  record  of  the  "p"  shows 
small  vibrations,  indicating  that  the  larynx  continued 
to  vibrate  instead  of  stopping  as  it  should  have  done. 


Fig.  14.  —  Mouth  record  of  "stutter"  spoken  by  a  stutterer. 

There  is  an  initial  gasp  followed  by  a  strong  "s"  and  then  an 
immensely  prolonged  "t."  There  is  then  another  gasp.  The  rest 
of  the  word  is  normal. 

A  normal  record  of  the  word  "  stutter  "  is  given  in 
Fig.  13.  It  registers  the  rush  of  air  for  the  ^'  s  "  by 
the  upward  rising  I'ne.  The  line  suddenly  falls  as 
the  lips  are  closed  for  the  'H."  It  rises  very  sud- 
denly as  the  lips  are  opened  to  let  out  a  puff  of  air, 
the  explosion  of  the  "  t."  Then  follow  the  vibrations 
of  the  vowel  ''  u."  The  line  falls  as  the  tongue  closes 
the  mouth  for  the  second  "  t  "-sound  (indicated  by 
"  tt  '0  •  The  word  ends  with  a  series  of  vibrations  for 
the  final  vowel  which  is  indicated  by  "  er.'' 


32  STUTTERING  AND   LISPING 

A  mouth  record  (Fig.  14)  of  the  word  "  stutter  " 
by  a  patient  shows  an  initial  gasp  followed  by  a 
strong  ^'  s."  Then  comes  an  immensely  prolonged 
^^tJ^  At  the  end  of  the  ^H  "  there  is  another  gasp. 
The  rest  of  the  word  shows  no  marked  abnormality. 

The  beginning  of  a  stutterer's  attempt  to  say 
"  Peter  Piper's  peppers  "  is  given  in  Fig.  15.     A  short 


Fig.  15. —  Mouth  record  of  "Peter  Piper's  peppers"  spoken  by  a  stut- 
terer. 

The  stutterer  makes  a  gasp  and  a  vowel  sound  followed  by  a 
blowing  sound  before  he  can  say  the  first  "p."  Such  sounds  are 
called  "  starters."  The  "  p  "  is  long  and  has  a  violent  explosion.  The 
"t"  is  so  short  as  to  be  almost  lacking.  The  "starter"  is  repeated 
before  each  word. 

gasp  is  followed  by  a  long  vowel  that  sounds  like  "u'' 
in  "up."  Then  comes  a  blowing  noise  made  by  the 
lips ;  it  is  the  same  as  the  Greek  sound  "  ph  "  which 
is  similar  to  the  English  "f."  All  this  has  to  be 
done  before  he  can  say  the  first  "p."  The  "p" 
is  long ;  it  has  such  a  violent  explosion  that  the  large 
vibrations  of  the  recording  lever  persist  for  a  con- 
siderable time.     The  very  short  vowel  "  e  "  shows  no 


SYMPTOMS,    FORMS,   NATURE 


33 


100 


peculiarities.  The  "t"  was  made  so  abnormally 
short  as  to  almost  entirely  disappear.  The  last 
vowel  (indicated  by  ''er")  was  much  prolonged. 
The  "  uf  "-sound  was  repeated  before  each  word ;  the 
entire  phrase  be-  200 
ing  spoken  about 
as  follows:  ''uf- 
Peter  uf  Piper's  uf- 
peppers." 

The  difference 
between  the  use 
of  the  laryngeal 
tone  by  normal 
speakers  and  by  a 
stutterer    can    be 


170 

14C 

130-^ 

P 

papa 

a 

P 

a 

95 

0  TOO  200  300  400  50f) 

Fig.   16.  —  Melody   plot  for   "papa"  spoken 
normally  (Fig,  8). 

Each  wave  of  the  vowels  is  measured. 
The  pitch  of  the  tone  corresponding  to 
each  wave  is  then  calculated.  The  results 
are  indicated  by  a  line,  —  the  "melody 
plot"  —  which  shows  how  the  tone  rises 
and  falls.  The  melody  plot  shows  that 
the  voice  started  at  a  tone  of  170  vibra- 
tions in  the  first  vowel  and  descended  to 
140.  In  the  second  vowel  it  started  at 
130  and  descended  to  95. 


illustrated  by  comparison  of  the  melody  of  the  voice 
in  the  two  records  shown  in  Figs.  8  and  9.  The 
length  of  each  vowel  vibration  is  measured  under  a 
microscope.  The  number  of  vibrations  of  this  length 
that  would  occur  in  one  second  is  calculated.  This 
is  the  pitch  of  the  laryngeal  tone  at  that  instant. 
The  result  is  marked  by  a  dot  on  cross-section  paper. 
A  line  connecting  these  dots  shows  the  rise  and  fall 
of  the  voice.     Such  a  diagram  is  termed  a  ''  melody 


34 


STUTTERING  AND   LISPING 


plot."  The  melody  plots  for  the  records  in  Figs.  8 
and  9  are  given  in  Figs.  16  and  17.  The  monotony 
of  the  stutterer's  voice  is  evident. 

The  view  of  the  nature  of  stuttering  that  I  have  pro- 
posed differs  essentially  from  the  prevalent  theories. 

According  to  Kussmaul  the  enunciation  of  each 
single  sound  occurs  correctly;  the  trouble  is  in 
connecting  the  consonants  with   the   vowels;    this 


200 


100 


125 

125 

p 

papa 

a 

P 

a 

"90 

100 


200 


300 


400 


500 


600 


700 


800 


900 


Fig.    17.  —  Melody  plot  for  "  papa  "  spoken  by  a  stutterer  (Fig.  9). 

The  first  vowel  maintained  a  tone  of  125  vibrations  throughout. 
The  second  vowel  maintained  the  same  tone  for  a  while  and  then 
fell  to  90. 

occurs  because  the  respiratory,  laryngeal,  and  enun- 
ciatory  muscles  do  not  act  harmoniously.  This  is 
contrary  to  fact.  In  the  case  of  a  stutterer,  every 
sound  without  exception  is  made  more  or  less  in- 
correctly. Even  when  he  is  speaking  with  apparent 
smoothness,  the  hypertonicity  of  the  muscles  (p.  12) 
is  present,  and  the  strained,  monotonous  laryngeal 
tone  is  heard.  The  cramps  affect  the  sounds  them- 
selves regardless  of  how  they  are  followed.     A  stut- 


SYMPTOMS,   FORMS,   NATURE  35 

terer  does  not  stick  on  '^  t "  because  a  vowel  follows 
it,  but  because  he  feels  he  cannot  say  that  particular 
word;  for  example,  he  may  stick  on  ''stove"  but 
not  on  "  sto  "  or  "  stone." 

The  statement  that  stuttering  consists  purely  of 
a  wrong  form  of  breathing  simply  neglects  all  the 
other  defects  in  the  stutterer's  speech.  The  theory 
that  it  consists  essentially  in  an  incoordination  of 
breathing  and  speech  movements  quite  misrepresents 
the  condition ;  such  incoordination  appears  typically 
in  the  speech  of  a  person  intoxicated  with  alcohol, 
whose  speech  is  different  in  every  detail  from  that 
in  stuttering. 

The  theory  that  stuttering  consists  in  an  exaggera- 
tion of  the  consonants  in  speech  merely  takes  account 
of  the  results.  Since  the  stutterer  usually  has  his 
cramps  on  initial  consonants,  these  sounds  occupy  a 
great  deal  more  time  than  the  following  vowels,  and 
also  than  the  following  consonants.  There  are, 
moreover,  cases  where  the  patient  stutters  on  initial 
vowels,  as  in  '^a-a-a-apple."  Since  in  German  the 
initial  vowel  really  begins  with  a  consonant  (the 
glottal  catch  corresponding  to  the  spiritus  lenis  in 
Greek),  this  might  be  considered  as  consonant  stutter- 


36  STUTTERING  AND  LISPING 

ing.  But  in  English  the  initial  vowels  begin  clearly. 
Moreover,  the  cramped  laryngeal  tone  is  present  in 
every  vowel  in  every  case  of  stuttering.  The 
lengthening  and  exaggeration  of  consonants  or 
vowels  are  the  results  of  the  cramps,  and  these 
cramps  are  the  results  of  other  conditions. 

Every  one  of  the  above  theories  neglects  just  the 
one  vital  characteristic  of  the  disease,  namely,  that 
the  defect  is  due  to  the  fact  that  the  stutterer  thinks 
some  other  person  is  listening  to  him.  As  long  as  he 
is  alone,  he  can  speak  perfectly.  When  a  stutterer, 
who  has  become  so  accustomed  to  me  that  he  speaks 
perfectly  in  my  presence,  is  placed  at  the  telephone, 
he  will  continue  to  speak  perfectly  as  long  as  he  sees 
my  finger  on  the  switch  that  cuts  it  off ;  the  moment 
it  is  removed  he  knows  that  "  central  ^'  will  hear  him 
and  he  begins  to  stutter. 

It  has  been  asserted  that  stuttering  consists  essen- 
tially in  the  fear  of  speaking.  This  is  true  as  an  ex- 
planation of  why  the  person  stutters  as  badly  as  he 
does  when  once  the  disease  is  developed.  The  fear  of 
speaking  is  perhaps  the  most  prominent  symptom  in 
stuttering  just  as  in  stage  fright,  but  an  underlying 
cause  for  this  fear  must  be  sought  for. 


SYMPTOMS,   FORMS,   NATURE  37 

The  assertion  has  been  made  that  stuttering  is 
related  to  tics,  to  compulsive  acts,  to  the  phobias, 
and  to  writer's  cramp.  These  conditions  are  not 
only  utterly  different  from  stuttering,  but  also  from 
each  other. 

The  essential  of  a  tic  is  a  persistently  repeated 
impulse  to  a  special  movement  that  can  be  suppressed 
voluntarily  for  a  short  time.  The  tic  movement 
always  involves  more  than  one  muscle;  it  is  the 
remainder  of  a  movement  that  was  once  purposive, 
Guch  as  sniffing,  twisting  the  head,  blinking  the  eye, 
etc.  The  tic,  unlike  stuttering,  does  not  involve 
any  inaccuracy,  uncertainty,  or  primary  embarrass- 
ment or  fear. 

A  compulsive  act,  like  that  of  touching  all  the 
posts  as  one  goes  along,  or  that  of  never  stepping  on 
the  cracks  in  the  sidewalk,  etc.,  arises  from  an  al- 
most irresistible  impulse  to  do  a  certain  compli- 
cated act.  Like  the  tic,  the  impulse  can  be  repressed 
for  a  while ;  but  the  impulse  is  to  a  definite  compH- 
cated  act,  not  to  a  single  movement,  as  in  a  tic. 
Unlike  stuttering,  the  compulsive  acts  are  not  pro- 
duced by  any  fear,  and  do  not  show  any  inaccuracy 
or  uncertainty. 


38  STUTTERING   AND    LISPING 

The  phobias  are  characterized  by  irresistible  fears 
of  objects,  acts,  or  places,  as  the  fear  of  filth,  the  fear 
of  committing  an  act  of  desecration,  the  fear  of  cross- 
ing open  places,  etc.  The  patient  with  a  phobia 
knows  that  his  fear  is  absurd.  The  stutterer's  fear 
is  not  only  reasonable  but  also  thoroughly  justified. 

Writer's  cramp  is  a  fatigue  of  the  nerve  centers 
due  to  overexertion  in  writing.  It  is  a  dull  pain  or 
an  actual  cramp,  quite  unconnected  with  any  mental 
disturbance.  The  cramp  is  spastic  and  not  clonic. 
There  is  no  mental  compulsion,  as  in  tics,  compulsive 
ideas,  and  phobias.  There  is  no  embarrassment  or 
fear,  as  in  stuttering.  Penmanship  stuttering  has 
been  observed  in  one  case.^  The  embarrassment  and 
fear  were  like  those  of  the  stutterer ;  the  cramplike 
repeated  movements  were  not  like  those  of  writer's 
cramp,  but  were  the  same  as  those  of  oral  stuttering. 

According  to  my  view,  stuttering  is  a  disease 
marked  by  the  following  cardinal  symptoms  :  1,  psy- 
chic hypertonicity  and  spasms  of  the  muscles  of 
speech,  2,  anxiety  (embarrassment  or  fear),  3,  fixation 
of  these  conditions  by  habit,  and  4,  the  existence  of 
these  symptoms  only  in  the  presence  of  other  persons. 

1  Scripture,  "Penmanship  Stuttering,"  Jour.  Am.  Med.  Assoc, 
May  8,  1909,  Vol.  LII,  p.  1480. 


SYMPTOMS,    FORMS,   NATURE  39 

The  enumeration  of  the  symptoms  does  not  suffice 
to  indicate  the  nature  of  stuttering.  The  fact  that 
one  child  becomes  a  stutterer  through  imitation  or 
fright  or  an  exhaustive  disease,  while  another  does 
not,  indicates  some  deeper  difference  in  the  mental 
or  nervous  constitution. 

Analysis  of  the  stutterer's  condition  of  mind 
always  shows  a  serious  disturbance  in  his  attitude 
toward  other  people.  Most  patients  are  shy  and 
timid;  the  boldness  or  indifference  in  other  cases  is 
only  a  kind  of  bravado  to  cover  up  timidity.  Much 
of  this  timidity  is  undoubtedly  due  to  the  effects  of 
the  stuttering,  but  its  intensity  is  often  out  of  all 
proportion  to  the  occasion.  It  may  well  be  that 
timidity  is  the  basis  on  which  stuttering  arises.  If 
this  is  true,  stuttering  would  then  be  a  condition 
in  which  timidity  shows  itself  by  a  peculiarity  in 
speech. 

Social  timidity  shows  itself  in  mental  symptoms 
that  are  approximately  the  same  in  stutterers  and 
non-stutterers ;  there  are  the  same  strained  feelings 
toward  other  people,  the  same  bashfulness,  etc. 
The  bodily  symptoms  are  also  similar;  the  muscles 
of  the  body  are  more  tense  than  they  should  be ; 


40  STUTTERING   AND    LISPING 

there  is  often  also  the  flushing  of  the  face,  etc. 
There  are  even  resemblances  in  speech.  The  timid 
person,  who  is  a  non-stutterer,  speaks  with  a  tense 
voice,  he  often  stumbles  over  his  words  and  some- 
times can  hardly  get  them  out ;  he  often  sticks  or 
reduplicates  like  a  stutterer.  If  this  ^^stuttery," 
timid  speech  can  be  supposed  to  be  developed  and 
firmly  fixed  in  a  set  of  habits,  the  result  would  be 
true  stuttering. 

The  fact  that  stuttering  arises  only  in  some  cases 
of  timidity  and  not  in  others  indicates  that  there  is 
some  other  element  in  the  disease.  The  following 
observations  may  perhaps  suggest  what  it  is.  In 
several  cases  there  has  been  a  determined  effort  to 
get  rid  of  the  trouble  and  perfect  good  faith  on  the 
part  of  the  patient,  yet  I  have  had  the  feeling  that 
at  the  bottom  of  his  soul  the  patient  really  did  not 
wish  to  be  cured.  This  reminds  one  of  some  forms 
of  hysteria,  psychasthenia,  and  neurasthenia,  where 
the  disease  is  really  produced  by  the  patient  in  order 
to  obtain  some  end,  although  he  is  absolutely  un- 
conscious of  this  self-production.  It  may  be  sug- 
gested that  stuttering  is  a  defect  which  tends  to 
exclude  the  person  from  the  society  of  his  fellows, 


SYMPTOMS,    FORMS,   NATURE  41 

and  that  persons  who  already  have  this  unconscious 
tendency  instinctively  seize  upon  such  a  means  of 
encouraging  it. 

The  same  mental  condition  as  that  underljang 
stuttering  is  found  in  many  cases  of  neurasthenia  and 
psychasthenia  where  quite  other  symptoms  (head- 
ache, tremor,  anxiety,  etc.)  appear  instead  of  the 
speech  trouble.  It  is  often  a  cause  of  wonder  why 
some  neurotic  patients  are  not  stutterers.  If  we 
assume  that  the  impulse  to  segregation  from  society 
will  use  the  most  hkely  and  effective  means  for  its 
purpose,  we  understand  why  it  naturally  seizes 
upon  the  speech  function.  We  also  understand 
that  it  will  more  readily  disturb  the  speech  when 
the  mechanism  of  normal  speech  is  less  firmly  fixed, 
as  after  exhausting  diseases,  fright,  or  injury  by 
imitation.  When  the  normal  speech  mechanism  is 
strong,  the  psychasthenic  impulse  must  find  some 
other  outlet. 

Stuttering  is  therefore  a  diseased  state  of  mind 
which  arises  from  excessive  timidity  and  shows  itself 
in  speech  peculiarities  that  tend  toward  a  condition  of 
segregation  which  will  enable  the  person  to  avoid  oc- 
casions where  he  will  suffer  on  account  of  timidity. 


CHAPTER  III 

DIAGNOSIS 

The  mere  repetition  of  a  word  or  of  an  initial  sylla- 
ble is  often  termed  stuttering.  Such  repetitions  occur 
to  every  one  at  times,  especially  in  embarrassing 
situations.  One  stutterer  said  that  every  boy  in 
the  class  stuttered  when  reciting  Latin.  Various 
other  conditions,  such  as  hysteria,  multiple  tics,  in- 
juries to  the  brain,  etc.,  may  produce  repetitions  in 
speech.  Such  repetitions  do  not  have  the  same 
cause  or  the  same  systematic  regularity  as  the  repe- 
titions due  to  stuttering  in  the  habit  stage;  the 
muscular  movements  do  not  have  the  cramplike 
stiffness  peculiar  to  stuttering.  The  symptoms  are  not 
the  result  of  embarrassment  and  fear,  as  are  those  due 
to  stuttering  in  the  fright  stage.  It  is  quite  im- 
portant to  distinguish  between  the  disease  called 
stuttering  —  namely,  the  disease  whose  character- 
istics have  been  described  in  the  preceding  chapters 

—  and  the  repetitions  often  called  stuttering  which 

42 


DIAGNOSIS  43 

are  found  in  various  other  diseases.     These  repeti- 
tions might  be  called  ''pseudo-stuttering." 

''Organic  lisping"  is  an  inaccurate  form  of  speech 
produced  by  abnormal  conditions  of  the  speech  organs. 
It  may  be  illustrated  by  the  case  of  the  boy  who  says 
''sh"  for   ''s"    on  account   of  a  very  high   palate. 
Tongue-tie  may  cause  the  child  to  use  ''th"  for  ''s." 
The  hsp    disappears    when    the    organic    defect    is 
corrected.     There    is    no    resemblance    between  the 
sounds  of  organic  hsping  and  those  of  stuttering ;   in 
the  former  the  sounds  are  incorrect  because  they 
are  incorrectly  made,   in    the   latter   because    they 
are     made     with     too     much     force.      Tongue-tie 
never  produces  stuttering  directly.     I  have  had  a 
small   boy    with    tongue-tie    who    both    hsped    and 
stuttered.     Upon  cutting  the  tongue  band  he  ceased 
to    lisp    immediately,    and   stopped    the    stuttering 
after  three  days.    The  tongue-tie  caused  the  hsp,  and 
the  embarrassment  over  the  hsp  caused  the  stuttering. 
A  full  account  of  organic  hsping  is  given  in  Part  11. 

''Neghgent  lisping"  is  a  term  that  may  be  applied 
to  those  errors  of  speech  that  are  due  to  defective 
perception  and  execution  of  sounds.  Thus  '^w"  is 
used  for  ''r"  because  the  child  does  not  clearly  per- 


44  STUTTERING   AND   LISPING 

ceive  the  difference  and  because  he  does  not  take 
the  trouble  to  produce  the  more  difficult  muscular 
adjustments  required  for  the  '^r. "  Most  frequently 
the  tongue  is  pressed  a  trifle  too  hard  against  the 
palate  so  that  it  closes  up  the  small  passages  re- 
quired for  ^^s"  and  ^Hh, "  thereby  turning  both  cf 
these  sounds  into  'H"  and  producing  "tun/'  "toap, " 
etc.,  for  '^sun/'  "soap,"  etc.,  or  "tick"  for  "thick." 
Often  "t"  is  used  for  "k, "  as  "tandy"  for  "candy." 
The  defective  sounds  remain  constant,  whereas 
they  change  in  stuttering.  The  lisper's  "s"  is 
always  defective,  whereas  the  stutterer  may  have 
trouble  on  initial  "  s  "  but  not  on  final  "  s. "  Negligent 
lisping  occurs  in  normal  or  phlegmatic  or  mentally 
dull  children,  whereas  the  stutterer  is  always  nervous  ; 
some  hspers,  however,  become  much  embarrassed 
by  their  defects,  and  some  even  become  stutterers  on 
account  of  embarrassment.  Negligent  lisping  is 
treated  in  detail  in  Part  II. 

"Stammering"  is  a  term  sometimes  applied  to 
the  speech  defects  indicated  by  the  German  word 
"Stammeln";  these  are  the  same  as  those  just  de- 
scribed under  the  term  "negligent  lisping."  Often 
the  term   "stammering"   is   applied  in  a  confused 


DIAGNOSIS  45 

way  to  a  case  of  stuttering  where  the  patient  sticks 
in  his  speech  rather  than  redupUcates  his  consonants. 
Most  often  the  term  is  used  as  identical  with  ' '  stutter- 
ing." It  is  better  to  ehminate  the  word  ''stammer" 
in  order  to  avoid  confusion. 

'' Neurotic  lisping"  is  a  disease  described  here  for 
the  first  time.  The  person  may  speak  with  general 
indistinctness,  appearing  to  mumble  the  words,  or 
the  incorrectness  may  be  confined  to  special  sounds. 
One  girl  of  thirteen  lisped  over  all  the  consonants. 
She  was  an  excessively  nervous  child,  and  she  spoke 
with  incredible  rapidity.  As  she  was  gradually 
quieted  down,  the  lisping  decreased.  It  became  evi- 
dent that  the  excessive  nervous  tension,  combined 
with  self-consciousness,  produced  a  tense  condition 
of  the  vocal  organs  alhed  to  that  of  stuttering.  She 
could  not  produce  the  smooth  and  delicately  ad- 
justed movements  of  normal  speech  because  her 
muscles  were  overtense.  Another  girl  of  twelve  was 
afflicted  with  partial  deafness,  which  had  made  it 
hard  for  her  to  learn  to  speak.  Being  a  sensitive 
child,  the  correction  of  the  parents  and  the  embarrass- 
ment and  fear  before  them  had  caused  nervousness. 
She  spoke  improperly  because   she  over-innervated 


46  STUTTERING   AND    LISPING 

the  speech  muscles.  Neurotic  hsping  occasionally 
occurs  in  stutterers.  The  lisping  may  sometimes  ap- 
pear in  only  a  few  sounds,  the  others  being  distinct. 
One  case  of  this  kind  lisped  only  on  ^^s" ;  the  cause 
was  a  fright  that  had  left  the  person  excessively 
nervous.  The  overtension  of  the  speech  muscles,  the 
nervous  condition  of  mind,  and  the  similarity  of 
causation  in  some  cases  point  to  a  close  relation  of 
nervous  lisping  to  stuttering ;  they  might  perhaps  jus- 
tify the  term  ''spastic  stuttering."  Neurotic  lisping 
may  be  distinguished  from  stuttering  proper  by  the 
fact  that  the  overtension  of  the  muscles  is  a  con- 
stant one ;  the  mental  excitement  seems  also  to  be  a 
steady  condition,  not  varying  as  in  stuttering.  Fur- 
ther details  are  given  in  Part  II. 

Bad  cases  of  ''cluttering"  (hasty  mumbled  speech) 
are  often  confused  with  stuttering.  Although  the 
clutterer  speaks  with  excessive  rapidity  and  slurs 
over  the  details  of  his  words,  and  although  he  breathes 
improperly  and  sometimes  sticks  in  the  middle  of  a 
sentence,  yet  the  defects  are  the  result  of  over- 
excitement  and  eagerness  rather  than  of  anxiety  and 
fear,  as  in  the  case  of  the  stutterer.  The  clutterer 
speaks  better  the  more  he  is  concerned  about  his 


DIAGNOSIS  47 

speech,   the  stutterer  the  less  he  worries   about  it 
(see  Part  II j. 

''Tic  speech"  or  ''choreatic  stuttering,"  or  the 
speech  of  the  " post-choreatic  neurosis"  fif  the  terms 
may  be  permitted)  is  characterized  by  a  system  of 
spasmodic  movements  of  constant  character  that 
break  up  the  speech  in  a  way  somewhat  hke  ordinary 
stuttering.  The  trouble  originates  in  an  attack  of 
acute  chorea.  After  this  has  passed,  the  patient  may 
retain  various  spasmodic  movements  which  are  no 
longer  due  to  the  cause  of  the  original  disease,  but  are 
really  "tics"  derived  from  the  choreatic  movements. 
Such  cases  are  frequently  diagnosed  as  "chorea," 
whereas  they  are  really  "multiple  tics."  The 
patient  with  this  form  of  speech  usually  has  various 
other  spasmodic  movements  of  the  head,  arms,  etc. 
The  speech  itself  does  not  show  the  regularity  of 
stuttering.  The  stutterer  will  stick  constantly  for 
a  while  on  certain  consonants ;  his  trouble  is  nearly 
always  in  getting  started.  The  tic-speaker  usually 
begins  smoothly  and  catches  and  jerks  at  any  mo- 
ment ;  there  is  no  regularity  or  system  in  the  sounds 
he  stumbles  over.  The  mental  attitude  of  the 
stutterer  is  characterized  by  anxiety  and  fear ;    the 


48  STUTTERING  AND   LISPING 

tic-speaker  does  not  hesitate  to  speak  at  any  time, 
and  is  usually  unabashed  by  his  defect. 

The  speech  defects  of  '^hysteria"  have  often 
been  confused  with  stuttering.  In  one  case  the 
patient  upon  being  asked  a  question  would  hesitate 
a  moment,  turn  her  eyes  to  one  side,  and  make  a 
movement  of  the  head  as  if  she  had  just  waked  up  to 
the  question,  and  then  answer  with  a  slight  difficulty 
at  the  start.  The  symptom  was  absolutely  constant. 
Corneal  and  pharyngeal  reflexes  were  lacking ;  she 
was  readily  hypnotized;  all  of  these  pointed  to 
hysteria.  Another  patient  could  not  say  words 
beginning  with  ''w"  because  a  word  beginning  with 
that  letter  had  once  shocked  his  feelings.  Sometimes 
the  patient  stumbles  over  all  words  relating  to  certain 
topics.  Such  patients  do  not  show  the  cramplike 
action  of  the  stutterer,  and  do  not  have  trouble  all 
through  their  speech;  the  laryngeal  tone  is  not 
monotonous;  the  mental  attitude  is  quite  different. 
They  are  cases  of  hysteria,  or  of  ^'hysterical  pseudo- 
stuttering,^'  and  not  of  true  stuttering. 

The  diagnosis  of  ''hysterical  mutism''  has  been 
made  in  cases  where  the  stutterer's  fright  made  him 
speechless  in  the  doctor's  presence.     Older  persons 


DIAGNOSIS  49 

that  complain  simply  of  inability  to  speak  when 
meeting  strangers  will  be  found,  on  close  observation, 
to  stutter  more  or  less  perceptibly. 

'^Hysterical  aphonia"  results  in  a  whispered  or 
faint  tone  of  the  voice  that  is  present  continuously  in 
a  sentence ;  there  are  no  cramps  in  the  mouth  or  face. 
The  stutterer  never  has  the  whispered  or  the  faint 
voice;  he  nearly  always  has  some  cramps  in  the 
mouth  or  face.  He  may  become  speechless  for  a 
short  time,  but  this  does  not  occur  with  the  hysteri- 
cal patient. 

In  the  '^ spastic  speech"  of  cases  of  infantile  cere- 
bral palsy,  the  characteristic  is  over-innervation 
of  all  the  muscles  used  to  express  the  idea.  In 
speaking  a  word  the  patient  contracts  not  only 
the  muscles  of  breathing,  of  the  larynx,  and  of  the 
organs  of  enunciation,  as  many  a  stutterer  would, 
but  also  makes  strong  contractions  of  all  the  facial 
muscles.  The  overcontractions  are  those  that  would 
be  needed  to  overcome  heaviness  of  movement,  and 
are  often  not  well  coordinated,  whereas  the  stutterer's 
overcontractions  are  those  that  express  embarrass- 
ment and  are  perfectly  coordinated  for  the  purpose. 
In  spastic  speech  there  is  none  of  the  stutterer's  fear. 


50  STUTTERING  AND    LISPING 

The  over-exertion  is  continued  throughout  the  sen- 
tence. The  syllables  are  equal  in  length,  and  are 
laboriously  enunciated. 

A  record  of  the  word  ''papa"  made  by  a  patient 
with  ''cerebral   birth  palsy"  is  shown  in  Fig.   18. 


Fig.  18.  —  Mouth  record  of  "papa"  in  a  case  of  spastic  speech. 

The  occlusion  (straight  Hne)  for  the  "p"  is  followed  by  a  blowy 
explosion  (upward  curve) .  The  vowel  vibrations  are  blown  upward. 
All  the  sounds  are  longer  than  those  of  the  normal  record  (Fig.  8) . 

The  explosion  for  each  of  the  "  p  "s  is  of  the  blowing 
kind,  more  like  those  of  the  stutterer's  record  (Fig. 
9)  than  those  of  the  normal  record  (Fig.  8).  The 
vowels  are  also  blown,  as  shown  by  the  position  of  the 
Une  with  the  fine  vibrations.  All  the  sounds  are 
lengthened,  particularly  the  last  vowel. 

In  "motor  aphasia"  the  patient  cannot  find  the 
words  or  sounds  to  express  what  he  wants  to  say. 
There  is  usually  a  history  of  trauma  or  apoplexy. 
Stuttering  nearly  always  begins  in  childhood ;  aphasia 
is  usually  connected  with  old  age  or  injury.  The 
excessive  nervousness  of  the  aphasic  person  some- 
times resembles  that  of  the  stutterer ;   it  has  partly 


DIAGNOSIS  51 

the  same  origin  in  anxiety  to  get  out  the  words 
and  in  fear  of  being  ridiculous.  There  is  no  ex- 
cessive muscular  tension  or  cramp  of  the  speech 
muscles.  The  laryngeal  tone  is  normal,  and  not 
monotonous.     Words  or   parts  of  words  or  letters 


Fig.  19.  —  Mouth  record  of  "papa"  in  a  case  of  motor  aphasia. 

The  syllable  "pa"  is  spoken  gently.     A  long  pause  follows.    The 
word  is  then  spoken  correctly. 

may  be  repeated  (pseudo-stuttering),  but  the  cramps 
of  the  stutterer  do  not  occur. 

One  aphasic  repeated  a  word  or  a  phrase  over  and 
over  before  he  could  go  on;  for  example,  ''Doctor  — 
doctor  —  doctor  Brown  told  me  to  come  here.  I 
bring  —  I  bring  —  I  bring  what  you  told  me  —  I 
bring  —  bring  —  bring,  yes,  bring,  bring,  I  bring, 
etc;"  or  ''I  say  to  my  —  to  my  —  to  my  —  I  say 
that  to  my  niece,  I  have  my  girl,  I  have  my  girl, 
etc."  This  is  pseudo-stuttering.  A  stutterer  does 
not  repeat  a  word,  but  only  sounds  or  syllables;  he 
would  have  said  ''D-d-doctor,"  "I  b-b-bring,"  etc. 

A  record  of  "  papa  "  by  this  patient  is  reproduced 
in  Fig.  19.     The  first  syllable  is  spoken  normally; 


52  STUTTERING   AND   LISPING 

there  are  no  cramps.  Then  follows  a  pause,  after 
which  the  word  is  spoken  correctly.  This  should  be 
compared  with  a  record  of  the  same  word  by  a  stut- 
terer in  Fig.  9.  Sometimes  the  patient  will  repeat 
the  first  syllable  a  dozen  times  with  pauses  between. 
He  says  that  he  is  for  a  while  unable  to  recollect 
what  the  second  syllable  is. 

This  aphasic  syllable  or  word  repetition  is  utterly 
different  in  its  cause  and  its  symptoms  from  true 
stuttering.  Kussmaul  calls  it  "  aphatic  stuttering.'^ 
It  is  simply  one  of  the  phenomena  of  aphasia. 

In  its  early  stages  '^ multiple  sclerosis"  sometimes 
produces  a  kind  of  pseudo-stuttering ;  the  later 
stages  are  characterized  by  a  scanning  speech  in 
which  each  syllable  is  brought  out  with  a  distinct 
effort.  The  characteristic  anxiety  of  the  stutterer 
is  absent. 

In  "hereditary  ataxia''  (Friedreich's)  the  speech 
is  slowed,  clumsy,  and  often  scanning.  There  may 
be  hesitation,  but  there  is  no  true  stuttering  and  no 
stutterer's  fear. 

In  ^'progressive  bulbar  paralysis"  the  injury 
to  the  nuclei  in  the  pons  and  bulb  produces  weak 
action  of  the  muscles  of  lips,  tongue,  pharynx,  and 


DIAGNOSIS  53 

larynx.  The  sounds  of  speecli  become  mumbled  and 
indistinct.  The  blurred  pronunciation  can  hardly  be 
confused  with  stuttering.  The  weakness  of  the 
laryngeal  muscles  produces  hoarseness,  dullness, 
monotony,  lowering  of  pitch,  and  finally  loss  of 
voice.     There  is  no  fear  of  speaking  as  in  stuttering. 


Fio.  20.  —  Mouth  record  of  "papa"  in  a  case  of  bulbar  paralysis. 

For  "  p  "  the  line  rises  steadily  ;  this  shows  that  the  lips  were  not 
closed  completely.  The  strong  vibrations  for  the  vowels  correspond 
to  the  bellowy  character  of  the  voice.  For  the  second  "  p  "  the  lips 
were  closed,  but  the  larynx  continued  to  vibrate.  The  limits  be- 
tween the  sounds  are  much  blurred. 

A  record  of  "  papa  "  spoken  in  a  case  of  progressive 
bulbar  paralysis  is  reproduced  in  Fig.  20.  Instead 
of  an  occlusion  and  an  explosion  for  the  initial  "  p  " 
there  is  a  steady  rise  of  the  line,  showing  that  the  lips 
were  not  closed  completely  at  any  moment.  For  the 
second  '^  p  "  there  is  also  only  a  slight  narrowing  of 
the  lips  instead  of  a  closure ;  the  larynx  does  not  stop 
vibrating  for  a  moment  as  it  should. 

In  '^pseudo-bulbar  paralysis"  the  speech  is  im- 
perfectly enunciated ;  it  may  be  nasalized ;  it  may 
become  an  unintelligible  mumble;  it  may  even 
closely  resemble  stuttering  (pseudo-stuttering).  The 


54  STUTTERING   AND   LISPING 

weakness  of  the  muscles  shows  itself  not  only  in 
speech,  but  also  in  every  movement;  e.g.  panting, 
whistling,  singing,  sticking  out  the  tongue,  etc. 
Similar  disturbances  occur  in  swallowing  and  cough- 
ing. The  eye  muscles  and  the  extremities  are  usually 
affected.  It  is  characteristic  that,  although  the 
voluntary  control  of  these  muscles  is  injured,  yet 
they  act  perfectly  in  response  to  emotional,  auto- 
matic, and  reflex  stimuli ;  for  example,  although  the 
patient  cannot  move  his  lips  or  the  facial  muscles 
when  talking,  yet  he  laughs  and  cries  and  expresses 
his  emotions  in  an  exaggerated  manner.  In  his 
speech  the  muscular  action  is  too  weak,  in  contrast 
to  the  too  strong  action  in  stuttering.  There  is  no 
anxiety,  as  in  stuttering. 

In  the  speech  of  ^'general  paralysis"  the  sounds  are 
often  slurred  over,  there  are  no  cramps  in  enunciation, 
and  single  sounds  are  not  repeated.  Mistakes  occur 
readily  in  the  combination  of  the  parts  of  a  word. 
For  example,  the  paralytic  patient  will  say  ^^ar- 
trallery"  or  '^rartrillery, "  but  it  will  be  said  without 
cramps.  A  stutterer  would  say  ^^a-a-a-artillery" 
or  ^^art-t-tillery."  The  paralytic  can  often  speak  the 
word  correctly  by  trying  very  hard;    the  stutterer 


DIAGNOSIS  55 

speaks  better  as  he  speaks  gently.  The  paretic 
'' syllable  repetition"  is  quite  different  from  true 
stuttering;  the  paralytic  will  say  ^^hippo-po-po-pot- 
musmus,"  the  stutterer  would  never  say  anything 
like  this,  though  he  might  say  ''hip-pop-p-potamus." 
The  diagnosis  of  '^ insanity"  with  commitment  to 
an  asylum  occurred  in  the  case  of  a  very  bad  stutterer. 
When  excited,  he  would  go  through  the  most  extreme 
contortions  and  gesticulations  in  the  effort  to  get 
out  a  word,  and  would  finally  run  up  and  down  the 
room  in  wild  exasperation  at  his  inability  to  speak. 


CHAPTER  IV 

THERAPY 

The  prospect  of  a  permanent  cure  of  stuttering  is 
good,  provided  the  patient  is  willing  and  able  to  keep 
up  the  treatment  for  a  sufficiently  long  time.  The 
length  of  the  treatment  is  variable.  With  very 
young  children  the  cure  often  succeeds  in  one,  two, 
or  a  few  more  treatments.  Somewhat  older  children 
require  three  or  four  weeks  or  even  months  of  daily 
treatment.  Older  persons  are  sometimes  cured 
rapidly,  but  they  are  often  very  difficult  to  manage. 
When  the  patient  receives  treatment  only  during 
visits  to  the  physician  two  or  three  times  a  week,  a 
permanent  cure  may  require  six  months  or  a  year. 
When  there  is  weakness  of  character,  a  permanent 
cure  can  be  effected  only  by  remedying  the  under- 
lying defect  at  the  same  time. 

The  first  step  in  the  cure  of  stuttering  is  to  look 

after  the  patient's  bodily  and  mental  health.     Most 

stutterers  are  anemic,  all  are  nervous.     Fresh   air 

56 


THERAPY  57 

and  exercise,  proper  liyfi;iene  of  meals,  sleep,  and 
moral  lia})its,  regulation  of  school  or  office  work, 
cod-liver  oil,  iron,  arsenic,  etc.,  are  indicated.  The 
treatment  of  the  stuttering  is  often  useless  unless  the 
patient  is  treated  for  his  nervousness ;  the  two 
troubles  aggravate  each  other,  and  they  should  be 
treated  simultaneously.  Nose  and  throat  should  be 
in  good  condition;  turbinates,  polyps,  septum,  ade- 
noids and  tonsils  should  be  treated  if  necessary. 

At  the  outset  it  is  usually  necessary  to  explain  to 
the  parents  how  the  stutterer  is  to  be  regarded  at 
home,  or  to  the  patient  himself  how  he  is  to  regulate 
his  life.  The  home  attitude  during  the  fright  stage 
should  be  such  that  the  stutterer  should  be  encouraged 
to  forget  himself.  His  attempts  at  new  ways  of 
speaking  should  not  be  commented  upon.  Mistakes 
and  relapses  should  not  be  noticed.  The  patient 
should  never  be  blamed.  With  rare  exceptions  the 
attempt  of  a  parent  to  correct  or  help  the  stutterer 
is  an  added  irritation  and  a  direct  hindrance. 

The  treatment  of  stuttering  is  based  on  the  follow- 
ing principles. 

The  ''principle  of  a  new  method  of  speaking"  is 
founded  on  two  facts  :  first,  that  the  stutterer  speaks 


58  STUTTERING   AND    LISPING 

in  an  abnormal  voice,  which  we  may  call  the  ^'  stut- 
ter voice";    and,  second,  that  he  does  not  stutter 


QUETER    SPEECH 


THOUGHT    TO 
BE    EXPRESSED 


Eemot;onal    DISTURBANCC 
"^STUTTERING    SPEECH 

)^ 

VOCAL    ORGANS 

Fig.  21.  —  Scheme  to  illustrate  the  mechanism   of  stuttering. 

When  the  stutterer  attempts  to  express  a  thought  in  his  usual  voice, 
he  is  obliged  by  the  emotions  connected  with  speaking  to  cramp  his  vo- 
cal muscles.  If  he  expresses  his  thought  by  singing,  by  queer  modes  of 
speech,  or  in  any  other  way  unusual  for  him,  he  has  no  difficulty. 
The  normal  way  of  speaking  differs  so  much  from  the  stutterer's 
voice  that  it  is  just  as  unusual  to  him  as  the  queerest  voice  can  be. 
He  cannot  stutter  in  a  normal  voice. 

when  he  expresses  his  ideas  in  any  other  voice,  such 
as  the  singing  voice. 

The  scheme  shown  in  Fig.  21  expresses  these  two 
facts.  When  the  stutterer  tries  to  express  a  thought  in 
the  presence  of  another  person,  the  action  of  his  speech 


THERAPY  59 

is  interfered  with  by  the  emotional  condition  (emi^ar- 
rassment  or  fear)  that  is  aroused  at  the  same  time. 
He  therefore  speaks  in  his  stutter  voice.  If  he  tries 
to  express  the  thought  in  any  other  way  than  the 
usual  one,  the  emotional  disturbance  does  not  arise. 
This  explains  the  famiUar  fact  that  a  stutterer  never 
has  any  trouble  when  he  sings  what  he  wants  to  say. 

Since  the  patient  does  not  stutter  if  he  speaks  in 
any  unusual  way,  he  can  be  taught  to  speak  in  some 
kind  of  an  odd  voice.  The  stutterer  can  at  any 
time  speak  without  stuttering  if  he  will  use  an 
abnormally  low  voice,  or  an  abnormally  high  one,  or 
if  he  will  drawl  the  vowels  or  slur  the  consonants, 
or  if  he  will  speak  in  a  choppy  staccato  voice,  and  so 
on.  These  are  the  methods  of  the  '^stammer 
schools"  and  ''stutter  curers."  They  are  objec- 
tionable because  they  leave  the  patient  with  a  queer 
voice.  He  is  Hkely  to  have  it  told  him  that  the 
''cure  is  worse  than  the  disease."  He  usually  gives 
up  the  queer  voice  after  a  while  and  becomes  a  stut- 
terer again  because  the  queer  voice  itself  produces  em- 
barrassment and  he  naturally  feels  hke  discarding  it. 

The  essential  point  is  that  the  stutterer  feels  his 
manner  of  speech  to  be  different  from  his  stuttering 


60  STUTTERING   AND   LISPING 

voice.  One  patient  could  never  dictate  to  his 
stenographer.  I  found  that  he  could  not  distin- 
guish one  note  from  another  in  music.  I  told  him  to 
sing  what  he  wanted  to  dictate.  He  did  so  without 
the  slightest  hesitation  or  difficulty,  in  what  he 
supposed  to  be  a  singing  voice;  it  did  not  differ, 
however,  from  his  stuttering  voice,  except  in  being 
slightly  easier  and  more  natural.  As  long  as  he 
thought  he  was  singing,  he  did  not  stutter,  although 
he  did  not  sing.  The  cure  was  a  failure  because 
he  refused  ^'to  make  a  fool  of  himself  by  singing  to 
his  stenographer."  To  have  enlightened  him  con- 
cerning the  fact  that  he  did  not  sing  would  have 
destroyed  the  belief  that  he  was  singing  and  would 
have  made  him  a  stutterer  again.  There  was  no 
way  out  of  the  dilemma. 

There  is  another  way  of  speaking  which  is  unusual 
to  the  stutterer,  namely,  the  way  in  which  the  nor- 
mal person  speaks.  When  he  speaks  in  this  way,  he 
does  not  and  cannot  stutter.  The  therapeutic  pro- 
cedure on  this  principle  will  therefore  be  to  teach 
him  to  speak  normally.  Each  of  the  abnormalities 
that  appear  in  his  speech  has  to  be  determined  and 
corrected.     The  result  is  perfectly  normal  speech. 


THERAPY  61 

This  is  the  only  method  of  cure  that  should  be 
permitted. 

The  ^'principle  of  relaxation"  is  used  to  aid  in 
overcoming  the  emotional  condition  of  the  stutterer. 
It  is  pointed  out  to  him  that  he  speaks  in  a  hard, 
strained  voice.  He  is  taught  to  speak  softly,  melo- 
diously, and  pleasantly.  It  is  quite  effective  to  get 
him  to  go  through  various  exercises  while  lying 
down  and  trying  to  doze ;  a  hypnoid  or  a  hypnotic 
doze  aids  in  relaxation. 

The  '^ principle  of  habit  formation"  implies  that 
the  new  way  of  speaking  is  to  be  drilled  into  the 
patient  till  it  becomes  a  habit.  The  greatest  diffi- 
culty lies  in  the  fact  that  speech  is  so  automatic  that 
we  practically  never  think  before  we  speak.  The 
training  requires  the  patient  at  first  to  think  how  he 
is  to  speak  each  time  before  he  actually  speaks.  The 
first  steps  require  him  to  repeat  sentences,  poems, 
etc.,  after  the  instructor.  This  is  continued  till 
proper  habits  are  formed.  The  final  result  must  be 
a  purely  automatic  system  of  speech  habits.  If  the 
treatment  falls  short  of  complete  automatism  in 
the  new  form  of  speech,  the  patient  will  probably 
drop  the  habit  and  become  a  stutterer  again. 


62  STUTTERING  AND   LISPING 

The  '^principle  of  spontaneity"  is  requisite  be- 
cause, when  the  patient  has  learned  to  repeat  per- 
fectly, he  will  still  be  unable  to  do  so  when  he  speaks 
of  his  own  accord.  A  gradually  increasing  amount 
of  spontaneous  speech  is  introduced  into  the  treat- 
ment. A  good  method  is  for  the  instructor  to 
speak  declarative  sentences  and  questions  alter- 
nately; each  declarative  sentence  is  repeated  by 
the  patient,  but  each  question  is  answered.  He  is 
urged  to  speak  the  answers  in  the  same  tone  and 
manner  as  the  questions  Gradually  longer  answers 
and  then  free  conversations  are  introduced.  The 
patient  should  finally  talk  freely  and  perfectly. 
Another  method  is  to  give  the  patient  something  to 
read.  At  first  the  instructor  reads  with  him;  soon 
the  instructor  drops  out  for  an  ever  increasing 
number  of  words  until  the  patient  can  read  alone. 

The  '' principle  of  increasing  embarrassment" 
arises  from  the  fact  that,  even  when  the  patient  has 
learned  to  speak  perfectly  in  the  presence  of  the 
physician  or  the  instructor,  he  is  unable  to  do  so 
under  other  circumstances.  The  patient  is  taught 
to  speak  properly  before  a  few  other  persons  or 
before  a  class.     Still  more  difficulty  is  introduced  by 


THERAPY  63 

making  introductions,  speaking  over  the  telephone, 
buying  in  stores,  reciting  in  school,  etc.  For  the 
introduction  exercise  the  stutterer  practices  at  first 
privately  and  then  with  gradually  increasing  num- 
bers of  strangers.  The  other  problems  are  met  by 
exercises  to  develop  confidence. 

The  '^principle  of  equilibration"  responds  to  the 
fact  that  some  patients  are  abnormally  lively  and 
expressive  while  others  are  retiring  and  depressed. 

The  former  type  is  quite  the  usual  one  among 
small  boys.  They  are  characterized  by  excessive 
volubility;  their  speech  runs  in  a  stream,  they 
reply  before  you  have  finished  your  remark,  they 
continually  insert  remarks  in  the  conversation  of 
others,  they  often  talk  and  act  in  a  way  that  is 
'Afresh"  or  even  impertinent.  It  often  happens  that 
the  patient  stutters  only  when  he  gets  into  such  a 
flippant  mood,  or  when  he  thinks  of  something  funny. 
This  is  the  mood  expressed  in  the  jokey  style  of  talk 
of  the  mining  camp,  of  the  swaggering  tough,  and  to  a 
lesser  degree  of  college  boys.  The  very  essential  of 
the  cure  lies  in  repressing  such  patients.  It  is 
explained  to  them  not  only  that  their  manner  is 
improper  and  offensive,  but  also  that  their  stuttering 


64  STUTTERING  AND   LISPING 

is  due  to  their  lack  of  self-control.  They  are  re- 
quired to  keep  silent  when  others  speak,  to  silently 
count  four  before  speaking,  to  speak  in  time  to  a 
metronome,  to  speak  no  unnecessary  word,  etc. 

The  other  type  of  stutterer  is  ashamed  to  speak, 
or  is  dejected  and  depressed.  Such  are  many  of  the 
older  boys  and  the  young  men  and  women.  They 
need  to  be  encouraged.  It  is  explained  to  them  that 
there  is  a  chance  for  them  to  escape  from  their 
bondage  and  that  life  may  become  bright  and  happy. 
Moreover,  they  are  not  to  take  their  defect  so  seri- 
ously; others  have  the  same  trouble.  It  is  useful 
to  accompany  such  patients  to  stores,  to  their  homes, 
etc. ;  a  helpful  word  is  inserted  when  needed.  It  is 
pointed  out  to  them  how  much  their  speech  improves 
from  week  to  week.  When  a  patient  has  serious 
trouble  on  certain  occasions,  for  example,  buying  in 
a  certain  store,  it  is  often  stimulating  to  bet  him  that 
he  will  have  the  same  trouble  next  time. 

The  ^^ principle  of  correct  thinking"  indicates  that 
the  abnormal  habits  of  thought,  which  a  stutterer 
always  acquires  to  a  greater  or  less  degree,  are  to  be 
corrected  by  appropriate  exercises. 

A  frequent  abnormality  is  that  of  getting  into  a 


THERAPY  65 

daze  at  each  effort  to  think.  The  patient  finds  that 
he  cannot  decide  promptly.  It  was  typical  of  one 
patient  that  upon  being  asked  ''Which  kind  of  dog 
do  you  like  best?"  he  hesitated,  and  grunted,  and 
finally  said,  ''I  really  cannot  say  which  I  like  best." 
He  was  cured  by  being  obliged  to  give  some  kind  of 
decision  quickly,  regardless  of  whether  it  was  correct 
or  not.  The  trouble  was  due  to  the  mental  flurry 
or  daze  that  had  become  a  habit.  Another  patient, 
when  leaving  a  house,  found  himself  unable  to  say 
^^Good-by"  because  some  friends  were  waiting  for 
him.  The  trouble  arose  from  a  conflict  between  the 
motive  to  hurry  after  the  friends  and  the  motive  of 
not  offending  the  host;  this  produced  a  mental 
daze  that  left  the  patient  speechless. 

The  school  exercises  of  another  patient  were 
learned  in  such  a  hazy  fashion  that  he  had  a  feeUng 
of  uncertainty  when  reciting ;  this  made  him  stutter 
violently.  The  habit  of  hazy  knowledge  may  extend 
to  every  topic  in  life ;  the  patient  must  be  trained 
to  know  perfectly  and  surely  what  he  does  know,  and 
to  recognize  exactly  what  he  does  not  know. 

The  ''principle  of  correct  enunciation"  responds  to 
the  fact  that  some  stutterers  enunciate  indistinctly 


66  STUTTERING   AND    LISPING 

or  incorrectly.  This  may  be  due  to  confused  and 
incorrect  notions  concerning  sounds  ;  such  a  condition 
is  a  form  of  '^negUgent  Hsping"  (Part  II,  Chap.  I). 
It  is  sometimes  due  to  a  general  excess  of  muscular 
effort;  this  is  a  form  of  '' neurotic  lisping"  (Part  II, 
Chap.  IV).  The  exercises  for  general  indistinctness 
(p.  157)  are  to  be  employed. 

An  important  principle  is  ''belief  in  the  success  of 
the  treatment."  When  the  belief  is  strong,  the 
patient  makes  his  readjustments  more  eagerly  and  is 
bolder  in  using  them  in  speaking  to  others;  the 
consequent  success  encourages  him  and  gives  him 
confidence.  This  ,  in  turn  leads  to  still  further 
success.  With  a  patient  who  is  consciously  or  un- 
consciously doubtful  of  the  outcome,  the  treatment 
becomes  laborious.  With  such  patients  and  with 
all  who  have  become  doubtful  through  failures  or 
relapses,  a  careful  psychanalysis  (see  below)  may  be 
needed  to  remove  the  doubt. 

A  thorough  ''correction  of  character"  has  to 
be  frequently  carried  out  in  order  to  produce  a 
complete  and  permanent  cure  of  the  stuttering. 
Whenever  possible,  the  patient  should  have  his 
entire  life  studied  and  regulated  by  the  physician. 


THERAPY  67 

Defects  of  intellect  and  morality  have  to  be  treated 
by  the  appropriate  methods.  The  neglect  to  reform 
a  person's  character  frequently  results  in  failure  of 
the  cure  to  be  permanent. 

The  ^'principle  of  subconscious  readjustment" 
recognizes  the  fact  that  only  a  very  small  portion 
of  our  mental  life  is  conscious.  From  earliest  infancy 
our  characters  have  been  developed  by  our  surround- 
ings and  by  the  experiences  we  have  passed  through. 
Our  past  has  been  mainly  forgotten,  but  its  results 
are  present  in  our  traits  of  character.  The  last  one 
to  have  any  idea  of  his  character  is  the  person  him- 
self. The  cause  of  the  stutterer's  trouble  is  entirely 
unknown  to  him.  It  is  purely  mental  but  it  is  sub- 
conscious, and  a  cure  is  often  possible  only  by  a  care- 
ful study  of  the  patient's  subconsciousness.  This 
can  be  done  only  by  the  group  of  methods  known 
as  "  psychanalysis  "  (Freud) .  Some  of  these  methods 
are  briefly  described  below. 

The  usual  conditions  under  which  the  cure  is  to 
be  achieved  include,  in  the  first  place,  individual 
treatment  at  the  physician's  office. 

My  method  is  to  give  the  patient  a  thorough 
mental  and  bodily  examination.     The  general  anam- 


68  STUTTERING   AND    LISPING 

nesis  covers  the  history  of  the  present  illness,  its 
presumable  cause,  heredity  (stuttering,  nervousness, 
asthma),  past  diseases,  education,  habits  (tea, 
coffee,  alcohol,  tobacco,  drugs,  sleep,  food,  work, 
sex),  appetite,  digestion.  The  general  status  includes 
the  size,  height,  weight,  general  condition  (nourish- 
ment, anemia,  exhaustion),  general  intellectual 
appearance,  urinary  analysis  (albumen,  sugar,  in- 
dican),  circulation  (heart).  Special  examination  of 
the  organs  used  in  speech  includes  the  nose  (septum, 
turbinates),  throat  (adenoids,  tonsils),  larynx  (ca- 
tarrhal conditions),  chest  (diameter  expanded,  re- 
tracted, capacity  by  spirometer) .  The  special  anam- 
nesis can  be  obtained  only  gradually  as  the  patient's 
friendship  is  gained.  It  should  furnish  all  sources 
of  nervous  strain  in  his  life.  He  is  asked  to  give 
a  most  careful  account  of  his  relations  to  the  other 
members  of  his  family,  to  his  schoolmates  or  his 
friends,  to  chance  acquaintances,  to  the  community, 
and  to  mankind.  On  each  of  these  topics  he  is  to 
compare  his  attitude  to  that  of  other  persons.  The 
object  is  to  relieve  him  of  all  feeling  of  strain  by  mak- 
ing him  realize  that  all  human  beings  are  built  on  the 
same  principles  as  he  is,  and  that  they  are  not  stran- 


THERAPY  69 

gers  before  whom  he  should  have  any  feehng  of  fear 
or  distance.  Since  the  patient  stutters  least  before 
persons  who  have  the  most  sympathy  with  him 
and  notice  his  trouble  least,  he  is  brought  to  feel 
that  the  whole  world  is  much  more  friendly  than  he 
supposed. 

Without  waiting  to  get  a  detailed  special  anam- 
nesis, work  may  be  begun  with  exercises,  and,  in 
some  cases,  with  psychanalysis. 

The  exercises  are  prescribed  at  each  sitting  as 
the  various  faults  show  themselves.  If  the  patient 
speaks  too  fast,  one  or  more  slowness  exercises  are 
ordered;  if  too  stiflfly,  melody  and  flexibility  are 
indicated;  if  the  breathing  is  incorrect  or  the  tone 
is  husky,  the  appropriate  exercises  are  noted,  etc. 
An  attendant,  who  has  been  listening  to  the  physi- 
cian's criticisms  and  explanations,  then  carries  out 
the  exercises  with  the  patient. 

Psychanalysis  is  begun  by  association  tests  and 
the  analysis  of  dreams,  as  described  below.  This 
immediately  brings  physician  and  patient  into  the 
closest  personal  relations ;  the  latter  will  discuss 
matters  that  he  would  not  mention  otherwise ;  the 
special  anamnesis  is  obtained   rapidly.     Moreover, 


70  STUTl^ERING   AND    LISPING 

it  brings  to  his  mind  many  important  events  of  the 
past  and  calls  his  attention  to  many  conditions  in 
the  present  otherwise  overlooked.  Finally,  it  is 
used  for  a  study  of  the  patient's  subconscious  con- 
dition. The  distinction  between  the  conscious  and 
the  subconscious  elements  of  his  mental  life  are  ex- 
plained. As  he  learns  to  realize  the  points  in  which 
his  mind  works  differently  from  what  it  should, 
he  involuntarily  proceeds  to  a  gradual  correction. 

The  physician  should*  gain  the  patient's  friend- 
ship and  devotion.  His  ability  to  develop  the  pa- 
tient's confidence  is  one  of  the  chief  factors  of  the 
cure.  The  patient  should  be  willing  to  devote  a 
large  amount  of  time  to  the  exercises  with  the  at- 
tendant. Office  treatment  has  the  advantage  that 
it  does  not  remove  the  patient  from  his  business  or 
school  and  also  that  it  enables  a  cure  to  be  gradually 
worked  out  in  the  environment  in  which  the  pa- 
tient must  live. 

The  final  success  or  failure  of  the  treatment  de- 
pends largely  on  the  patient's  determination  to 
persist  until  the  cure  is  complete.  Sometimes  a 
patient  will  spend  many  months  with  only  gradual 
improvement ;    finally  the  resistances   and   ancient 


THERAPY  71 

habits  suddenly  break  down  and  the  patient  is  cured 
rapidly.  He  should  make  up  his  mind  that  at  any 
cost  he  will  continue  treatment  until  he  speaks  per- 
fectly. When  he  does  speak  perfectly,  he  should  not 
drop  the  treatment.  He  should  return  at  steadily 
increasing  intervals  for  examination  and  for  any 
needed  revision.  When  he  reaches  a  six-months  in- 
terval, he  should  make  a  permanent  arrangement 
to  return  at  such  an  interval ;  this  is  not  too  much 
to  ask,  even  a  dentist  makes  that  demand.  It  is 
true  that  some  cases  get  well  in  a  few  treatments, 
and  that  most  cases  do  not  have  relapses ;  but  no 
one  can  tell  beforehand  how  any  one  case  will  turn 
out. 

Another  form  of  treatment  is  that  at  an  institu- 
tion. The  patient  lives  with  the  physician  and 
attendants  in  a  special  house.  He  suddenly  breaks 
off  all  connection  with  his  past  hfe  and  enters  upon 
a  novel  series  of  experiences  in  strange  surroundings 
where  people  constantly  supervise  his  speech.  His 
entire  manner  of  life  —  bodily  and  mental  — is 
subject  to  regulation.  This  form  is  very  effective 
when  it  can  be  carried  out.  The  separation  from 
the  family  is  often  absolutely  necessary  for  a  cure. 


72  STUTTERING   AND   LISPING 

Treatment  by  classwork  has  a  great  advantage 
in  the  feehng  of  soUdarity  it  awakens  and  in  the 
inspiration  of  being  cured  together  with  others.  It 
is  used  in  the  office  and  institutional  forms  of  treat- 
ment by  holding  daily  classes  for  the  various  exer- 
cises. The  interest  and  enthusiasm  that  can  be 
awakened  by  the  various  exercises,  by  the  tele- 
phoning, by  the  ticket  selling,  by  the  impromptu 
vaudeville,  by  the  debates,  etc.,  are  most  beneficial. 

In  the  speech  clinic  the  treatment  must  be  mainly 
in  small  groups  or  classes.  So  far  as  possible,  the 
physician  should  attend  to  the  patients  individually 
also. 

In  connection  with  the  public  schools  a  careful 
examination  should  be  made  by  a  competent  phy- 
sician of  every  child  who  does  not  speak  perfectly. 
Stuttering  must  be  carefully  distinguished  from  the 
other  nervous  defects.  In  all  cases  of  defective  enun- 
ciation (Part  II)  there  should  be  tests  of  intellectual 
development  also.  Many  of  the  stutterers  and  some 
of  the  lispers  can  be  treated  in  special  classes  con- 
ducted by  trained  experts  under  direction  of  the 
specialist.  Whether  these  classes  are  held  during 
school  hours,  after  school  hours,  or  in  vacation  is  a 


THERAPY  73 

matter  that  must  depend  on  local  conditions.  Quite 
a  number  of  the  stutterers  and  Hspers  must  receive 
special  individual  treatment.  The  other  speech  de- 
fects can  be  treated  only  on  directions  from  the 
specialist. 


CHAPTER  V 

METHODS    OF    TREATMENT 

The  object  of  the  treatment  is  to  give  the  stutterer 
a  normal  voice  and  a  normal  state  of  mind.  The 
following  methods  of  treatment  are  those  that  will  be 
found  most  efficacious  :  — 

Training  in  Melody  and  Flexibility 

The  tone  of  the  voice,  which  rises  and  falls  as  we 
speak,  is  produced  b^^  the  vibrations  of  the  vocal 
cords  in  the  larynx ;  it  may  properly  be  termed  the 
"laryngeal  tone." 

The  stutterer  cramps  the  muscles  of  the  larynx 
so  that  he  speaks  in  a  monotone.  The  cure  consists 
in  putting  melody  and  flexibility  into  his  laryn- 
geal tone. 

By  "melody"  we  mean  the  rise  and  fall  of  pitch 

for  successive  syllables.     Melody  may  be  indicated 

by  notes  on  a  staff  or  by  the  rise  and  fall  of  a  line. 

The  tones  on  which  the  words  "How  do  you  do?" 

74 


METHODS   OF   TREATMENT 


75 


may  be  sung  are  indicated  ])y  the  notes  in 
Fig.  22  or  by  the  Une  in  Fig.  23.  In  speech  each 
syllable  has  a  rise  and  fall  in 
pitch,  as  indicated  in  Fig.  24. 
The  speech  of  the  stutterer 

Fig.  22.  —  Notes   indicating 
is    monotonous    and    stiff,  hav-  how  the   phrase    "How 

.  do  you  do?"   is   to   be 

mg  neither  melody  nor  nexi-        sung. 
bility  (Fig.  25). 

A  record  of  the  word  ^^papa"  as  actually  sung  is 
reproduced  in  Fig.  26 ;  its  melody  plot  is  given  in 


How 


do 


do? 


you 

Fig.  23.  —  Line  indicating  how    the  phrase  "How  do  you  do?"  is  to  be 
sung  according  to  the  notes  in  Fig.  22. 

Fig.  27.  Comparison  of  Fig.  27  with  Figs.  16  and  17 
show  vividly  the  differences  in  melody  among  the 
three  forms  of  expression. 

The  pitch  of  the  laryngeal  tone  is  determined  by 


76 


STUTTERING   AND    LISPING 


the  degree  of  tension  of  the  vocal  cords.  To  vary 
the  pitch  constantly,  as  in  Fig.  27,  the  cords  must 
change  their  adjustment  at  every  instant ;  that  is, 
the  laryngeal  muscles  must  be  freely  and  delicately 


do 


How 


do 


you 

Fig.  24.  —  Line  indicating  how  the  normal  voice  should  rise  and  fall  in 
speaking  the  phrase  "How  do  you  do?"  with  a  melody  similar  to 
that  indicated  in  Fig.  23. 

poised  and  must  act  readily  and  accurately.     The 
stutterer,  however,  cramps  them  up  so  that  they  can 


How 


do 


you 


do? 

Fig.  25.  —  Line  indicating  the  monotony  of  the  stutterer's  voice  in  speak- 
ing the  phrase  "How  do  j^ou  do?" 

move  only  with  difficulty.  He  sticks  to  one  tone 
as  much  as  possible.  His  action  resembles  that  of 
a  child  who  cramps  a  pencil  tightly  in  his  hand ; 
he  can  draw  a  straight  line  with  a  ruler  to  guide  him, 
but  he  cannot  write  or  draw  gracefully. 


METHODS    OF    TREATMENT 


77 


The  laryngeal  cramp  may  be  broken  up  by  the 
^^ melody  cure."  The  stutterer  is  first  taught  to 
sing  a  song  or  a  phrase  while  accompanied  by  the 


Fig.  26.  —  Mouth  record  showing  the  word  "papa"  as  actually  sung. 
The  vibrations  of  each  vowel  are  of  the  same  length  throughout. 

piano  or  another  voice.  His  voice  will  rise  and  fall, 
as  indicated  in  Fig.  23,  and  he  will  have  no  stiffness 
or  cramps.     Then  he  must  speak  the  word  on  the 


200 


100 


250 

125 

^ 

p 

papa 

a 

P 

a 

100     200     300     400     500     600 
Fig.  27.  —  Melody  plot  to  Fig.  26. 


700 


800 


900 


same  notes,  first  with  and  then  without  musical 
accompaniment.  This  gives  him  the  idea  that  he 
must  put  melody  in  place  of  monotony. 

The  patient  now  learns  to  make  his  voice  '^  flexi- 
ble." The  instructor  pronounces  various  words  in 
such  a  way  that  the  laryngeal  tone  passes  over  an 
octave  in  the  first  important  vowel ;    this  may  be 


78 


STUTTERING   AND   LISPING 


called   the   ^^ octave  twist."    Fig.    28   indicates   the 
method  in  niusical  notation.     In  Fig.  29  the  general 

change  is  shown  by  a  line. 

In   going  over   the  octave  in 
this  way  the  voice  passes  from 


r 


Fig.  28.  — Octave  twist    the  chest  register   to   the  head 

in  musical  notation.  . 

register,  i^  or  these  registers  the 
laryngeal  adjustments  are  quite  different.  The  stut- 
terer always  speaks  in  the  chest  register.  If  he 
leaves  this  register,  he  must  relax  the  muscles,  that 
is,  he  must  drop  the  cramp  and 
start  a  new  adjustment.  An  an- 
alogy may  be  found  in  raising  a  fig.^29.  -  Octave  twist 
weight  by  the  arms  from  below  ^"^'^"*^^  ^^  "  ^^"" 
the  waist  to  over  the  head  One  set  of  muscles  pulls 
it  up  to  the  shoulder,  but  an  entirely  different  set  must 


Fig.  30.  —  Mouth  record  of  "papa"  spoken  with  the  octave  twist. 

The  waves  of  the  first  vowel  become  shorter  and  shorter;    this 
indicates  that  the  voice  rises  steadily. 

be  used  to  get  it  up  any  farther.  The  stutterer 
will  try  to  raise  his  voice  while  keeping  to  the  chest 
register ;    he  will  usually  stop  at  the  fifth  (c  to  g)  in- 


METHODS    OF    TREATMENT 


79 


stead  of  going  over  the  whole  octave  (c  to  c').  As 
long  as  he  does  this,  the  exercises  do  him  no  good 
whatever ;  he  must  be  persistently  trained  until  the 
full  octave  becomes  easy. 


300 


200 


<oo 


^ 

^ 

/ 

125  "•^^ 

125 

1> 
papa 

a 

V 

a 

500 


600 


0  100  200  300  400 

Fig.  31.  —  Melody  plot  to  Fig.  30. 

The  voice  rises  through  an  octave  in  the  first  vowel 


700 


800 


900 


A  record  of  the  word  ''papa"  spoken  with  the 
octave  twist  is  shown  in  Fig.  30.  The  waves  of  the 
first  vowel  become  shorter  and  shorter.     The  melody 


Fig.  32.  —  Mouth  record  of  "papa"  spoken  with  an  unsuccessful  at- 
tempt at  the  octave  twist. 

Although  the  vowel  waves  become  shorter  in  the  first  vowel,  they 
do  not  become  as  short  as  in  Fig.  30. 

plot  (Fig.  31)  shows  that  the  voice  rose  through  an 
exact  octave.  The  word  spoken  in  this  way  was 
much  longer  than  when  spoken  normally.  This  is 
usually  so  at  the  beginning  of  the  treatment,  but  as 


80 


STUTTERING   AND    LISPING 


the  patient  becomes  more  skillful  rio  more  time  is 
required  when  the  octave  twist  is  used. 

The  common  fault  of  the  beginner  who  sticks  to 
the  chest  register  and  fails  to  rise  a  full  octave  is  shown 
in  Fig.  32.  Although  the  waves  of  the  first  vowel 
become  shorter,  it  is  very  evident  that  they  did  not 


800 


0      100     200     300     400     500     600     700 

Fig.  33.  —  Melody  plot  to  Fig.  32. 

The  voice  fails  to  reach  an  octave  on  the  first  vowel. 

become  short  enough.     The  melody  plot  is  given  in 
Fig.  33. 

The  melodization  of  the  voice  goes  on  day  after 
day  until  the  stutterer  can  do  it  perfectly. 
Usually  all  the  other  kinds  of  stiffness  and  cramps 
disappear  together  with  the  laryngeal  stiffness,  be- 
cause the  stutterer  has  learned  to  speak  with  a  new 
voice,  that  is,  to  use  a  new  set  of  habits  free  from 
the  stuttering  impulse.  The  object  of  the  melodiza- 
tion and  the  octave  twist  is  relaxation  of  the  muscles 


900 


mp:thods  of  treatment  81 

of  speech.  When  this  has  been  accomphshed  per- 
fectly and  permanently,  the  person  may  speak  in  any 
way  he  pleases. 

Correcting  the  Vocal  Quality 
The  stutterer's  voice  usually  sounds  hoarse  and 
breathy.     This  is  due  to  improper  action  of  the  laryn- 
geal muscles  whereby  the  vocal  lips 
are  not  brought  closely  together. 
Perfect  closure  is  shown  in  Fig.  34 ; 
one  condition  for  the  breathy  tone  is 
shown  in  Fig.  35. 

Fig.  34.  — Perfect 

This  ^'stutterer's  hoarseness  "  can         closure  of  the  glot- 
tis. 
be  readily  corrected  by  exercises  in  The  vocal  cords 

1  .   1     ,1  ....  1  ,  close    tightly    to- 

wnicn  the  patient  smgs  and  speaks         gether  in  produc- 

^^ah"    with  the   glottal    catch    {coup  ^ngacear 

de  glotte)  at  beginning  and  end  of 
the   sound.      The   breath   is    held 
back   by   closing   the   glottis ;    the 
vowel  begins  suddenly  with  strong 
Fig.  3  5.— Glottis   vibratious ;  it  is  ended  by  snapping 
t™^  ^    ^^^^  ^   ^^^   glottis   shut   again.     Figs.   36 
The  cords  do   ^^^  37     -^^  records   of  a  normal 

not  come  together  ^ 

completely    and   English  vowel  and  a  vowel  marked 

the   tone    sounds 

husky  or  breathy,    ^ff   byglottal  catches ;    they  were 


82  STUTTERING  AND   LISPING 

made  by  the  apparatus  shown  in  Fig.  7.  Such  a 
vowel  begins  Hke  an  initial  vowel  in  German.  It 
is  usually  not  difficult  to  teach  this  to  the  patient. 
In  a  similar  way  the  patient  learns  also  to  speak 


Fig.  36.  —  Vowel  curve  with  normal  beginning  and  ending. 

The  voice  starts  to  vibrate  gently  and  ends  in  the  same  way. 

vowels.     Other  exercises  include  staccato  singing  and 
staccato  speaking  of  words  and  sentences. 

It  is  a  rather  common  fault  of  the  stutterer  to  let 
the  laryngeal  tone  (tone  of  the  voice)  cease  before  he 
ends  the  last  word,  whereby  the  end  of  the  word  is 


Fig.  37.  —  Vowel  curve  with  glottal  catch  at  beginning  and  ending. 

The  vocal  cords  close  tightly  together  and  then  open  with  a  sudden 
snap  as  the  vowel  begins.     The  vowel  is  ended  in  the  same  way. 

spoken  in  a  hoarse  whisper.  This  is  corrected  by 
having  him  snap  his  glottis  shut  as  he  ends  the 
word. 

Almost  invariably  stuttering  children  and  women 
use  a  voice  that  is  abnormally  low.  A  child  of  ten 
will  sometimes  speak  on  a  pitch  that  belongs  to  an 
adult.     For    correction    a    child    practices    singing 


METHODS   OF   TREATMENT  83 

songs  of  appropriate  pitch  ;  then  he  sings  sentences 
to  melodies  he  has  learned ;  then  he  half  sings,  half 
speaks  them  on  the  correct  tones,  and  finally  he 
simply  speaks  them  likewise. 

The  stutterer's  voice  is  usually  very  poor  in 
quality ;  it  sounds  thick,  as  though  the  throat  were 
stuffed  with  cotton;  there  is  none  of  the  sharp 
resonance  that  characterizes  a  good  singing  or 
speaking  voice.  The  method  of  correction  is  much 
the  same  as  for  a  student  of  vocal  music.  The  pa- 
tient is  trained  in  singing  scales,  arpeggios,  and  songs 
in  sharply  resonant  tones.  The  resonant  tone  is 
then  carried  over  into  speech. 

The  bad  quality  of  the  stutterer's  voice  is  due  to 
improper  action  of  the  various  muscles  involved  in 
speaking.  Some  of  these  muscles  are  not  sufficiently 
tense,  while  others  are  violently  contracted.  There 
seem  to  be  constant  relations  according  to  the  law 
that  a  lack  of  contraction  of  one  set  is  accompanied 
by  excessive  contraction  of  a  certain  other  set ;  thus, 
the  usual  failure  to  raise  the  velum  (soft  palate) 
sufficiently  is  always  accompanied  by  strong  con- 
tractions of  the  jaw  muscles,  a  condition  which  is 
not  only  unnecessary,  but  also  distinctly  pernicious. 


84  STUTTERING  AND   LISPING 

Another  common  defect  is  underaction  of  the  palato- 
pharyngei  (rear  arch  of  palate)  with  overaction  of  the 
palatoglossi  (front  arch).  Very  frequently  there  is 
overaction  of  the  mylohyoid  and  geniohyoid  whereby 
the  larynx  is  pulled  forward  away  from  the  backbone. 
Correction  of  such  defective  action  of  the  muscles 
used  in  speech  requires  special  exercises  (Part  III). 

Correcting  the  Breathing 
Stutterers  generally  have  cramps  of  the  breath- 
ing muscles,  or  they  breathe  in  hurried  gasps,  or 
they  blow  out  almost  all  their  breath  before  speak- 
ing, etc.  Usually  it  is  sufficient  to  train  the  stutterer 
to  take  a  breath  before  each  sentence  and  not 
to  let  any  of  it  out  before  he  speaks.  Exercises 
in  reciting  the  alphabet  several  times  in  one  breath, 
trying  to  say  as  much  as  possible  of  a  poem  like- 
wise, etc.,  are  useful.  Passive  and  active  exer- 
cises may  include  the  usual  special  calisthenic 
movements;  e.g.  chest  lifting  with  expansion,  up- 
ward arm  stretching  with  resistance,  standing-breath- 
ing with  arms  front  upwards  and  side  downwards, 
broad  standing  neck  front  sidewise  bending,  same 
with  trunk  twisting,  etc.  These  and  gymnastic 
exercises  (chest  weights,  running,  and  the  like)  aid 


METHODS   OF   TREATMENT  85 

in  giving  command  of  the  breathing  organs  and 
produce  a  feehng  of  confidence  in  them.  The  ab- 
normahty  in  breathing  usually  disappears  when  the 
stutterer  speaks  with  the  octave  twist  (p.  78). 

Developing  Slowness 

Almost  without  exception  stutterers  talk  too 
rapidly.  They  do  not  realize  this  fact,  and  they 
often  refuse  to  believe  that  they  talk  as  fast  as 
another  person  who  imitates  them.  They  have  two 
different  measures  of  rapidity,  one  for  themselves, 
the  other  for  other  persons.  The  correction  of  the 
fault  is  most  difficult ;  it  can  be  accomplished  only  by 
frequently  repeated  exercises  and  continual  remind- 
ers. Many  stutterers  are  cured  in  a  relatively  short 
time  of  everything  but  excessive  rapidity ;  owing  to  its 
persistence  they  repeatedly  relapse.  Others  seem  able 
to  speak  slowly  only  with  the  utmost  difficulty ;  in 
such  cases  a  cure  of  the  stuttering  is  often  impossible 
as  long  as  the  excessive  rapidity  is  not  overcome. 

Exercises  in  slowness  are  given  by  having  the  patient 
read  and  repeat  poems  and  sentences  in  time  to  a 
metronome  beating  54  times  a  minute.  Conversa- 
tion is  carried  on  likewise.  Later  the  conversation  is 
carried  on  just  as  slowly,  but  without  the  metronome. 


86  .         STUTTERING   AND   LISPING 

Speaking  with  the  metronome  usually  makes  the 
voice  hard,  unless  special  attention  is  given  to  soft- 
ness. Some  kind  of  pendulum,  such  as  a  weight 
on  a  string,  may  be  used  instead  of  the  metronome. 

Quite  useful  is  persistent  drill  in  speaking  with 
lengthened  vowels,  for  example,  ''The  su-u-u-u-un  is 
se-e-e-etting."  The  voice  must  be  kept  soft  and 
melodious. 

A  stutterer  often  thinks  he  gains  slowness  by 
putting  pauses  between  words,  whereas  each  single 
word  is  spoken  as  quickly  as  before.  This  produces 
jerky  speech. 

Training  in  Proper  Thinking 

A  common  trouble  is  the  inability  to  say  a  certain 
word  that  the  patient  wants  to  use.  He  may  be 
unable  to  read  the  names  of  a  list  because  he  may 
stick  at  any  one.  Or  he  is  constantly  looking  ahead 
in  his  conversation  for  words  he  may  not  be  able 
to  say,  and  he  spends  much  of  his  mental  energy  in 
substituting  other  words  for  them. 

Exercises  are  instituted  wherein  the  patient  gives 
the  names  of  objects  pointed  to.  This  he  does 
first  by  singing  them  and  then  by  speaking  them 
melodiously. 


METHODS   OF   TREATMENT  87 

The  most  common  defect  is  the  inability  to  go  di- 
rectly to  the  point  to  be  brought  out  in  speech.  A 
series  of  graded  exercises  is  to  be  used.  A  word  is 
called  out,  to  which  the  person  is  to  respond  with  the 
first  thing  he  thinks  of.  For  example,  when  the  in- 
structor says  ''rose,"  he  may  answer  ''flower."  This 
"simple  association  of  ideas"  is  to  be  made  as  quickly 
as  possible.  Measuring  the  "association  time"  with 
a  stop  watch  in  fifths  of  a  second  is  an  effective 
stimulus.  In  a  somewhat  more  difficult  exercise  the 
patient  is  required  to  make  such  associations  in  a 
series,  starting  from  a  given  word  and  making  as 
many  as  possible  in  ten  seconds.  For  example,  on 
hearing  the  word  "shoe"  the  patient  may  associate 
' '  lace-black-mourning-death-skeleton -medicine-doctor 
-cravat-etc."  Somewhat  greater  difficulty  is  in- 
volved when  all  the  associations  must  be  connected 
with  the  given  word.  Considerable  more  difficulty 
is  introduced  by  requiring  each  association  to  refer 
to  the  preceding  one  in  the  relation  of  (a)  part  to 
whole  or  (6)  whole  to  part.  For  example,  to  "room" 
the  association  might  be  "floor"  (6),  "board"  (h), 
"house"  (a),  "city"  (a),  "street"  (6),  "sidewalk" 
(6),  "stones"  (6),  "hills"  (a),  etc. 


88  STUTTERING  AND    LISPINd 

The  indefinite  or  dazed  condition  of  mind  of  the 
stutterer  applies  specially  to  his  notions  of  words. 
It  is  frequently  accompanied  by  inability  to  spell 
correctly ;  in  such  a  case  exercises  in  spelling  are  to 
be  used. 

Some  stutterers  develop  the  habit  of  frequently 
breaking  off  a  sentence  and  repeating  it  with  a 
changed  construction.  In  such  cases  this  may  not 
be  due  to  the  desire  to  avoid  certain  words,  but  to 
a  hesitating  habit  of  mind.  The  patient  should  be 
required  to  stick  to  his  original  sentences.  Exercises 
in  conversation  carried  on  entirely  in  short  declara- 
tive sentences  can  be  readily  devised. 

Correcting  Enunciation 

The  excessive  muscular  tension  of  the  stutterer  is 
to  be  combated  by  training  him  to  keep  his  muscles 
relaxed.  To  correct  individual  sounds  he  repeats 
words  with  that  sound,  first  with  the  sound  omitted 
and  then  with  the  sound  much  weakened.  If  the 
stutterer  is  troubled  by  initial  ^'b/'  he  reads  or  re- 
peats words  beginning  with  ^'b"  but  omitting  that 
letter,  for  example,  '^ -utter"  instead  of  '' butter ''; 
then  he  pronounces  the  same  word  with  a  very  faint 


METHODS   OF   TREATMENT  89 

"b,"  thus,  '' hiitter."  This  can  be  done  for  all 
sounds  with  which  lie  has  trouble.  Words  may  be 
found  in  a  dictionary  or  in  the  lists  in  Part  III. 

The  stutterer  often  places  his  tongue  or  lips  in- 
correctly while  stuttering.  He  may  learn  the  correct 
positions  for  any  sounds  that  trouble  him  and  may 


Fig.  38.  —  Mouth  record  of  the  stutterer's  correction  of  the  inspiratory 
"p"  in  Fig.  10. 

A  correct  occlusion  is  followed  by  a  fairly  successful  attempt  at  an 
explosion. 

try  to  get  these  positions.  On  the  principle  of  a 
new  method  of  speaking  (p.  57)  this  is  often  effective. 

For  many  stutterers  it  is  of  great  benefit  to  study 
the  positions  of  the  vocal  organs  for  the  vowel  sounds, 
as  shown  in  the  Plates  at  the  end  of  this  volume. 
The  stutterer's  incorrect  enunciation,  however,  usu- 
ally does  not  arise  from  the  placing  of  the  organs, 
but  from  abnormal  use  of  them. 

The  incorrectness  in  use  can  be  accurately  and 
strikingly  shown  by  the  graphic  method.  The  record 
of  a  stutterer's  inspiratory  "  p  "  is  given  in  Fig.  10. 
After  the  nature  of  the  defect  had  been  explained  to 


90  STUTTERING   AND    LISPING 

him,  he  tried  to  correct  his  mistake ;  with  the 
eighth  attempt  he  was  able  to  change  the  inspiratory 
^'  p  ^'  into  an  explosive  one,  as  shown  in  Fig.  38.  The 
result  was  not  a  very  good  '^p,"  but  the  essential 
fault  had  been  overcome. 

Developing  Confidence 

The  most  serious  disturbance  in  the  stutterer's 
emotional  condition  is  lack  of  confidence  in  his  ability 
to  speak  when  he  wants  to.  The  following  procedure 
is  serviceable  when  confidence  in  the  voice  is  utterly 
gone ;  it  can  be  abbreviated  as  may  be  necessary. 

A  tone  is  produced  on  a  piano,  organ,  or  some 
other  musical  instrument.  The  instructor  sings 
''ah"  at  the  same  time.  The  patient  then  sings 
it  with  the  instructor  while  the  piano  sounds.  This 
is  repeated  until  the  patient  declares  confidently 
that  he  is  sure  he  can  at  any  time  sing  a  tone  with 
the  instructor  and  the  piano.  Then  the  patient  is  to 
sing  the  tone  without  the  instructor.  If  he  hesitates, 
the  instructor  sings  also.  This  is  repeated  until  he 
declares  that  he  can  at  any  time  sing  a  tone  with 
the  piano.  Thereafter  two,  three,  and  more  tones 
are  used  in  the  same  way ;  a  declaration  of  confidence 


METHODS   OF    TREATMENT  91 

is  made  at  each  step.  Often  it  is  convenient  to 
begin  at  once  with  the  arpeggio  c-e-g-c'  instead  of 
single  tones.  The  preceding  steps  are  generally 
unnecessary,  as  it  is  usually  possible  to  begin  at  once 
either  with  singing  or  with  repeating  sentences. 

Children  are  usually  ready  to  sing  without  hesita- 
tion or  diffidence,  and  it  is  often  best  to  begin  the 
treatment  with  simple  songs,  because  the  child  knows 
that  it  never  stutters  when  it  sings.  If  the  child  is 
at  all  diffident,  the  instructor  sings  a  line  of  it  first 
alone ;  then  the  instructor  and  the  patient  sing  it  to- 
gether ;  then,  if  necessary,  both  start  together,  but 
the  instructor  drops  out  while  the  patient  keeps  on ; 
finally  the  patient  sings  the  line  alone.  In  this  way 
he  learns  to  sing  various  songs  with  the  fullest  con- 
fidence. Other  words  are  now  substituted  for  those 
of  the  first  line  of  the  song.  Sentences  like  ''This  is  a 
very  fine  day,"  ''My  name  is  Jack  Robinson,"  etc., 
are  sung  to  the  notes  of  the  piano.  Then  the 
instructor  sings  a  question  and  the  patient  sings  the 
answer;  for  example,  "What  is  your  name?"  "My 
name  is  Jack  Robinson."  The  patient  becomes 
fully  convinced  that  he  can  sing  anything  he  wants 
to  say. 


92  STUTTERING   AND    LISPING 

Having  gained  so  much  confidence  the  patient  is 
now  to  learn  that  he  can  always  speak  properly 
in  a  singsong  tone.  With  most  older  patients  the 
preceding  practice  in  singing  may  be  omitted  and  the 
singsong  may  be  started  at  once.  The  best  form  of 
singsong  is  a  frequently  repeated  ^'octave  twist" 
(p.  57).  The  patient  reads  or  repeats  with  the  in- 
structor a  sentence  or  a  poem  whereby  the  voice  is 
made  to  go  over  the  octave  several  times;  for 
example,  in  the  lines  ^^A  wee  little  boy  has  opened  a 
store"  the  octave  twist  would  be  used  in  ^^wee," 
'^boy,"  ^'o"  of  '^opened/'  and  ^^store."  Then  he 
repeats  such  material  after  the  instructor,  and  finally 
says  it  alone.  He  practices  till  he  is  quite  confident 
that  he  can  do  this  perfectly. 

The  instructor  reads  a  series  of  sentences  and 
questions  (as  in  a  traveler's  manual)  in  a  like  way. 
Whenever  a  statement  occurs,  the  patient  repeats  it. 
When  a  question  occurs,  he  answers  it  spontaneously, 
striving  to  keep  the  flexible  intonation.  The  most 
careful  watch  is  kept  on  the  octave  twist.  Some 
patients  persist  in  raising  the  voice  only  a  fifth  (c  to 
g)  instead  of  an  octave  (c  to  c')  when  repeating  a 
sentence.     In   answering   questions   all   patients   at 


METHODS   OF   TREATMENT  93 

once  drop  back  to  the  stiff  stutterer's  tone,  and  fail 
at  first  to  get  the  octave  twist.  The  patient's  answer 
should  be  used  as  a  sentence  for  repetition  whenever 
it  does  not  have  the  proper  intonation.  By  gradually 
developing  the  melodious  speaking  during  answers 
to  questions,  the  patient  ultimately  finds  that  he 
can  always  speak  independently  with  the  octave 
twist.  It  is  pointed  out  to  him  that  it  is  impossible 
to  stutter  and  to  use  the  octave  twist  at  the  same 
time ;  the  instructor  tells  him,  and  he  will  agree,  that 
he  need  never  stutter  again  if  he  can  only  remember 
to  use  the  octave  twist  always.  Of  course,  it  is  im- 
possible for  any  one  to  always  think  of  this  before 
he  speaks ;  therefore  this  way  of  speaking  must  be 
persistently  drilled  till  it  becomes  automatic.  It  is 
also  true  that,  even  though  he  forms  the  habit  while 
at  work  in  the  office,  he  will  at  once  drop  it  as  soon  as 
he  becomes  worried  by  the  presence  of  another 
person;  further  development  is  thus  necessary,  as 
follows :  — 

When  the  patient  has  gained  confidence  in  this 
work  with  the  instructor,  another  person  is  brought  in 
to  listen  to  him.  This  should  be  done  in  such  a  way 
as  not  to  embarrass  him.     If  the  patient  is  a  child; 


94  STUTTERING  AND   LISPING 

he  should  first  be  praised  for  his  progress,  and  then 
asked  if  he  would  not  like  to  let  his  mother  or  sister 
see  how  well  he  is  doing ;  the  other  person  should  be 
instructed  beforehand  to  praise  the  patient's  success. 
With  older  people  it  is  well  to  begin  with  the  presence 
of  the  doctor's  assistant  or  with  some  one  whom  he 
feels  not  to  be  a  critic.  It  may  be  necessary  to  go 
over  the  whole  routine  again  in  order  to  develop 
confidence  before  a  third  person.  When  this  is 
accomplished,  still  more  people  are  brought  in. 
It  is  often  very  inspiring  for  the  patient  to  go 
through  these  exercises  in  company  with  other 
stutterers.  Strangers  are  gradually  added  to  the 
group. 

If  the  patient  stutters  when  reading,  a  similar 
method  is  pursued.  He  first  reads  in  unison  with 
the  instructor.  The  latter  stops  for  a  few  words 
at  a  time,  leaving  the  patient  to  read  independ- 
ently. Gradually  the  stops  are  longer,  until  the 
patient  can  read  alone  perfectly.  He  is  to  learn  in 
a  similar  way  in  the  presence  of  a  third  person,  etc. 

Further  steps  in  developing  confidence  in  spon- 
taneous speech  are  taken  by  assigning  topics  con- 
cerning which  the  patient  must  say  a  few  words. 


METHODS   OF   TREATMENT  95 

For  example,  he  is  to  make  a  few  remarks  about 
the  furniture  in  the  room,  the  weather  this  morning, 
the  fine  time  he  had  last  summer,  the  best  way  to 
reach  his  home,  etc.  For  a  somewhat  more  difficult 
exercise  the  instructor  relates  or  reads  an  anecdote, 
a  short  story,  a  newspaper  item,  etc.,  and  the  patient 
is  then  required  to  give  the  gist  in  his  own  words.  As 
a  variation  he  may  first  read  the  material,  and  then 
•  tell  about  it.  He  may  be  required  to  give  short 
accounts  of  what  he  has  learned  in  school. 

Still  further  confidence  is  developed  by  requiring 
the  patient  to  stand  up  and  deliver  speeches,  either 
those   that   have   been  memorized,  or  spontaneous 
ones  on  topics  that   are  suggested.      This  is   best 
accomplished   with   a    group    of    stutterers.      The 
group  is  said  to  represent,  for  example,  a  dinner  at 
which  each  guest  has  to  respond  to  a  toast.     Again, 
the  group  is  a  party  of  tourists  on  an  automobile; 
one    of   the    patients    is    the    chauffeur;    they   all 
make  remarks  on  the  events  of  the  journey.     Again, 
the  group  is  in  a  restaurant;   one  of  the  patients 
is    the  waiter,   the   others  are  guests,   etc.     Entire 
scenes  are  acted  out,  whereby  spontaneous  speech 
is  constantly  required.     The  inspiration  of  such  a 
class  is  a  potent  factor  in  developing  confidence. 


96  STUTTERING   AND   LISPING 

More  difficult  situations  are  approached  by  imi- 
tating them  first  in  the  office.  A  table  with  objects 
rspresents  a  store.  The  patient  buys  and  sells  in  the 
presence  of  people.  When  he  can  do  this  perfectly, 
the  instructor  goes  with  him  to  stores  and  helps  in 
the  buying.  In  like  manner  a  ticket  booth  is  ar- 
ranged. For  classroom  work  a  class  is  organized 
and  lessons  in  arithmetic,  geometry,  Latin,  etc.,  are 
assigned,  as  may  be  appropriate.  The  patients  are 
called  up  to  recite,  to  demonstrate  at  the  board,  etc. 
Later  the  class  is  transferred  to  an  actual  classroom ; 
still  later  outside  instructors  are  brought  in,  older 
patients  are  appointed  instructors,  etc. 

The  special  difficulty  in  telephoning  is  met  by 
practicing  at  first  on  a  private  line  between  two 
rooms.  The  person  at  the  other  end  represents 
^'central"  and  the  people  called  up.  The  stutterer 
should  also  practice  the  part  of  "central "  in  order  that 
the  real  central  may  not  appear  so  strange.  When 
the  patient  no  longer  gets  excited,  the  main  line 
telephone  is  given  to  him,  but  the  switch  is  held  down 
so  that  there  is  no  connection.  Some  one  near  by 
speaks  as  if  he  were  "central."  When  the  patient 
feels   quite   confident    at    such    "dry   telephoning," 


METHODS    OF   TREATMENT  97 

the  switch  is  released  and  an  actual  call  is  sent. 
The  instructor  keeps  close  to  the  transmitter,  so  that 
at  the  slightest  hesitation  he  finishes  what  the  pa- 
tient wants  to  say. 

The  outside  situations  are  in  general  to  be  met  by 
an  attempt  to  get  the  patient's  mind  directed  to  the 
interest  of  the  thing  and  not  the  manner  of  presenting 
it.  For  school  it  is  desirable  to  go  over  the  exercises 
with  him  beforehand,  explaining  and  illustrating 
them  in  such  a  way  that  he  becomes  fascinated  with 
the  subject. 

The  appointment  of  stutterers  as  teachers  of  other 
stutterers  in  the  office  or  in  the  clinic  is  very  efiica- 
sious  in  developing  confidence. 

A  very  difficult  abnormality  of  feeling  that  occurs 
in  many  stutterers  is  the  mental  cramp  that  occurs 
when  they  are  suddenly  called  upon.  The  cramp  of 
expectation  in  a  mild  degree  is  perfectly  normal ; 
for  example,  while  waiting  for  cards  or  for  dice 
to  be  shown,  a  normal  person  usually  feels  a  slight 
flurry  and  holds  his  breath  for  a  moment.  With 
the  stutterer  this  goes  so  far  that  at  a  knock  on  the 
door  he  will  be  struck  absolutely  speechless  and  be 
unable  to  call  out.     To  meet  with  such  a  condition 


98  STUTTERING   AND   LISPING 

games  with  dice,  counters,  etc.,  may  be  practiced; 
thereafter  exercises  are  instituted  in  suddenly  answer- 
ing knocks,  and  in  other  situations  that  the  patient 
describes  as  troublesome. 

Confidence  is  also  developed  by  increasing  the 
loudness  and  carrying  power  of  the  patient's  voice. 
He  learns  to  speak  in  a  full,  resonant  tone.  Then  he 
is  removed  to  a  distant  room  and  forced  to  speak 
more  loudly.  The  loud,  resonant  voice  cannot  be 
produced  unless  the  speaker  has  a  feeling  of  self- 
confidence;  the  cultivation  of  the  voice  thus  de- 
velops the  feeling  directly.  Moreover,  a  decisive, 
commanding  voice  causes  those  who  hear  it  to  attend 
in  a  more  respectful  way  than  they  do  to  a  hesitating, 
timid  voice;  this  in  turn  produces  more  self-confi- 
dence in  the  speaker. 

Readjustment  to  Environment 

A  very  obstinate  abnormality  of  feeling  is  the 
stutterer's  altered  appreciation  of  the  relation  of 
himself  to  his  environment.  It  arises  not  only  be- 
cause he  knows  that  he  is  abnormal  in  his  speech, 
but  also  because  the  abnormality  makes  other 
people  treat  him  differently.     His  feelings  toward 


METHODS    OF    TREATMENT    ,  99 

other  people  are  therefore  very  different  from  those 
of  normal  persons.  This  leads  to  an  abnormal 
kind  of  life. 

With  some  patients  this  condition  has  to  be 
attended  to  from  the  start,  because  they  make  no 
progress  and  cannnot  be  cured  except  as  the  abnor- 
mality is  mitigated.  My  method  is  as  follows : 
I  first  attempt  to  establish  intimate  personal  rela- 
tions in  the  ordinary  ways  of  acquaintanceship,  so 
that  the  patient  feels  me  to  be  his  personal  friend.  As 
various  incidents  occur  or  as  topics  arise  in  conversa- 
tion, we  discuss  the  rules  of  conduct  of  the  average 
man,  and  we  condemn  extremes.  For  example,  a 
patient  fears  to  go  to  a  post  office  window  because 
he  stuttered  when  he  was  there  before  and  he  feels 
that  the  clerk  expects  him  to  stutter  and  will  be  im- 
patient. It  is  pointed  out  that  many  hundreds  of 
people  have  been  to  that  window  since  he  was  last 
there,  and  that  it  is  most  improbable  that  the  clerk 
would  remember  him.  Again,  the  business  of  the 
clerk  is  to  wait  on  all  customers  politely  and  pa- 
tiently; he  is  trained  to  allow  for  the  peculiarities 
of  customers,  some  of  which  are  more  trying  than 
stuttering.     Again,   he  is  not   allowed  by  his  em- 


100  STUTTERING   AND   LISPING 

ployers  to  show  the  shghtest  impatience  or  discour- 
tesy. Again,  the  postal  clerk  is  in  the  service  of  the 
government  of  which  the  stutterer  is  a  member  ;  he 
is  therefore  the  stutterer's  employee.  In  this  way 
the  stutterer  is  brought  to  a  correct  understanding 
of  the  relations  between  himself  and  the  clerk.  The 
other  situations  in  life  are  met  similarly. 

Readjusting  the  Subconscious 

Recent  psychological  work  has  shown  that  the 
instincts  and  desires  with  which  we  are  born  are 
gradually  modified  and  suppressed  until  they  have 
become  to  a  considerable  extent  unconscious. 
Moreover,  our  minds  are  trained  to  think  along 
certain  grooves  and  not  to  permit  thoughts  along 
other  ones.  Such  a  ^'  censorship "  makes  it  quite 
impossible,  for  example,  for  certain  thoughts  of  love 
to  arise  in  a  European  or  an  American  girl  that 
would  be  only  the  m.ost  natural  thoughts  for  the 
negress  in  Africa.  The  person  knows  nothing  about 
this  ''  censorship "  ;  it  has  been  drilled  into  the 
mind  until  it  governs  without  being  realized.  The 
difference  in  censorship  permits  certain  thoughts 
to  be  perfectly  natural  in  the  one  case  and  keeps 


METHODS    OF   TREATMENT  101 

them  entirely  absent  in  the  other.  Yet,  although 
absent  from  consciousness,  the  original  natural  forces 
persist  with  undiminished  energy.  When  properly 
directed  they  produce  the  normal  successful  indi- 
viduals ;  when  improperly,  they  produce  the  group 
of  diseases  known  as  neurasthenia,  psychasthenia, 
hysteria,  some  forms  of  insanity,  etc.  Our  thoughts 
and  emotions  are  controlled  largely  by  the  sup- 
pressed natural  instincts.  In  a  stutterer  some  of 
these  instincts  have  gone  wrong,  and  it  is  necessary 
to  readjust  them. 

A  minute  analysis  of  the  patient's  mind,  including 
the  subconscious,  is  often  necessary  to  a  cure.  The 
methods  of  psychanalysis  furnish  an  outline  of  the 
patient's  subconscious  life.  These  methods  may  be 
applied  to  the  stutterer  in  somewhat  the  following 
way:  — 

The  patient  is  alone  with  the  physician.  The  latter 
explains  that  the  mind  is  an  extremely  complicated 
organ  whose  ways  of  action  have  to  be  learned  by 
the  most  careful  study.  Since  stuttering  is  ac- 
companied by  a  somewhat  incorrect  action  of  the 
mind,  it  is  necessary  for  the  stutterer  to  carefully 
analyze  his  mental  condition.     The  physician  will 


102  STUTTERING   AND   LISPING 

train  him  to  do  this.    The  training  may  take  a  long 
time. 

We  judge  other  persons  and  interpret  their  actions 
on  the  basis  of  our  own  ideas ;  our  notions  of  other 
people  are  ^^egomorphic."  The  physician  there- 
fore asks  the  patient  to  note  down  from  time  to  time 
any  thoughts  or  criticisms  that  may  occur  to  him 
concerning  the  physician  personally.  The  patient 
may  reply,  for  example,  that  just  a  moment  ago  he 
had  said  to  himself  that  in  spite  of  his  age  and  calm- 
ness he  couldn't  help  thinking  that  the  doctor  was 
really  shy  and  bashful.  It  is  pointed  out  to  him 
that,  utterly  regardless  of  whether  his  judgment 
was  correct  or  not,  such  a  thought  would  probably 
not  have  occurred  to  a  man  of  fearless  disposition ; 
the  patient  had  sought  out  in  the  physician  some 
signs  of  his  own  trouble.  Of  course  this  was  not 
done  consciously;  the  thought  was  merely  the  re- 
sult of  many  past  experiences  and  habits  which  he 
had  forgotten,  but  whose  traces  remained  to  make  up 
his  character.  The  patient  is  warned  not  to  try  to 
produce  the  thoughts  concerning  the  physician,  but 
to  note  only  what  comes  unpremeditatedly.  The 
next  day  perhaps  he  says,  with  many  apologies,  that 


METHODS   OF    TREATMENT  103 

the  thought  had  occurred  to  him  that  the  doctor 
was  not  always  perfectly  frank  and  honest  with 
him;  the  reply  is,  ''It  is  you  who  are  not  perfectly 
open  and  honest  in  your  dealings  ;  you  have  a  tend- 
ency to  get  out  of  embarrassing  situations  even  at 
the  cost  of  some  truth.  Let  your  thoughts  wander 
as  they  will,  and  see  if  you  do  not  recollect  a  number 
of  cases  where  you  have  acted  in  this  way."  These 
spontaneous  revelations  of  traits  of  character  strike 
the  patient  with  great  force  and  automatically  start 
a  readjustment. 

During  the  day  the  restraints  of  life  do  not  let 
our  personalities  come  freely  into  play ;  we  automati- 
cally suppress  most  of  our  thoughts  and  emotions 
and  permit  only  a  certain  narrowly  limited  group  to 
develop.  Moreover,  the  ''censorship"  of  the  un- 
conscious does  not  permit  the  suppressed  instincts 
and  desiios  to  become  known  to  us.  In  sleep,  how- 
ever, the  censorship  is  somewhat  relaxed,  and  our 
innermost  ideas  and  feelings  come  forward  in 
dreams.  A  study  of  the  patient's  dreams  is,  there- 
fore, a  most  important  source  of  information.  The 
patient  receives  instructions  to  have  paper  and 
pencil  beside  the  bed   and   to   wake  up   and   write 


104  STUTTERING   AND   LISPING 

down  immediate^  one  dream  each  night.  The  ac- 
count is  read  off  by  him  to  the  physician.  The 
interpretation  of  some  parts  is  immediately  clear.' 
When  more  information  on  any  point  is  desired, 
the  patient  allows  his  mind  to  wander  through  a 
series  of  associations  starting  from  the  part  of  the 
dream  involved;  usually  the  explanation  is  forth- 
coming during  such  ^'running  associations." 

The  following  analysis  of  a  patient's  dream  will 
illustrate  the  method.  The  record  of  the  dream 
was :  — 

'^I  buy  a  ticket  to  some  place,  a  single  ticket 
because  I  am  not  coming  back.  At  a  certain  sta- 
tion on  the  way  I  get  off.  I  go  to  the  manager's 
office,  where  I  find  two  men  at  work  over  papers.  I 
stand  at  attention,  heels  together  in  the  German 
fashion.  The  man  has  an  American  military  cap 
of  dark  blue.  I  say  to  myself,  ^  Shall  I  give  a  mili- 
tary salute  or  take  off  my  hat  ? '  When  the  manager 
turns  around,  I  ask  for  the  return  of  my  money 
because  I  have  found  a  patient  on  the  train.  The 
manager,  who  has  now  become  a  younger  man, 
says  'Yes,  but  it  will  be  dear;  it  will  cost  one 
fare  plus  a  hemorrhage,  plus  an  infarct.'     I  reply, 


METHODS   OF   TREATMENT  105 

^  Never  mind,  the  expense  is  nothing  to  me.'  The 
assistant  reckons  out  what  I  am  to  get,  and  says  it 
will  be  about  fifty  per  cent." 

The  patient  had  originally  been  in  doubt  whether 
he  should  stop  for  treatment  in  this  town  or  go 
to  a  physician  farther  off.  Stopping  at  the  nearer 
place,  he  had  a  few  days  before  seen  the  doctor 
and  his  assistant  (manager  and  clerk)  at  a  scientific 
meeting.  The  doctor  had  told  him  he  could  not  be- 
gin treatment  till  next  week  (he  stands  at  attention 
waiting).  The  patient  holds  the  doctor  in  great  re- 
spect (the  dream  clothes  him  in  a  miUtary  costume, 
and  makes  him  manager  of  the  station).  The  doc- 
tor is,  however,  a  personal  friend ;  the  two  feeUngs 
are  present  at  the  same  time  and  the  patient  doesn't 
quite  know  how  to  act  (shall  I  give  a  formal  miU- 
tary salute  or  take  off  my  hat  in  a  friendly  manner  ?) . 
The  patient  naturally  expects  the  doctor  to  do  him 
enough  good  to  compensate  him  for  what  he  loses  by 
not  going  to  the  other  place  (I  ask  for  return  of  my 
money  for  the  part  of  the  journey  not  taken).  It  is 
characteristic  of  dreams  that  the  personalities  are 
often  changed.  The  patient  now  represents  himself 
as  a  doctor  who  has  found  a  patient  on  the  train. 


106  STUTTERING   AND   LISPING 

Instead  of  remaining  the  inferior  (the  patient),  he 
for  a  moment  gratifies  himself  by  feehng  that  he  is 
the  superior  (the  doctor),  who  is  about  to  treat  a 
patient.  The  dream  now  notes  that  the  doctor  is 
younger  than  the  patient  (manager  is  now  younger). 
The  patient  had  been  somewhat  worried  over  the 
probable  expense,  and  feared  what  the  dream  de- 
clares (it  will  cost  you  dear).  On  the  previous 
evening  the  patient  had  discussed  the  matter  with  a 
friend,  and  had  remarked  that  the  journey  was  not 
entirely  for  the  sake  of  the  treatment  (one  fare),  but 
also  to  learn  the  method;  he  had  also  complained 
that  the  treatment  cost  him  part  of  the  time  he  wished 
to  give  to  some  anatomical  work  (hemorrhage  plus 
infarct).  He  had  finally  concluded  that  he  was  ready 
to  pay  any  price  if  he  could  be  cured  (never  mind, 
the  expense  is  nothing  to  me).  The  fifty  per  cent 
seems  to  refer  to  the  fact  that  the  treatment  was 
taking  about  half  the  time  from  some  other  work. 
The  further  interpretation  was  made  in  connec- 
tion with  the  rest  of  the  treatment.  A  vitally 
important  defect  of  the  patient's  character  was  an 
inability  to  properly  and  promptly  understand  his 
relations  to  other  persons;    the  uncertainty  as  to 


METHODS   OF   TREATMENT  107 

how  he  should  approach  another  person  expressed 
itself  in  the  dream  as  the  doubt  concerning  how  he 
should  greet  the  doctor.  Another  defect  was  a  con- 
stant conflict  between  a  naturally  spendthrift  nature 
and  an  acquired  but  annoying  and  ill-judged  penuri- 
ousness ;  the  whole  dream  consisted  of  questions  of 
expense.  This  dream,  as  well  as  many  others,  ex- 
pressed the  patient's  thoroughly  egocentric  view  of 
the  events  of  life.  These  defects  of  character  were 
the  sources  of  the  patient's  trouble,  yet  he  had 
never  suspected  the  existence  of  any  one  of  them. 
As  they  were  revealed  by  psychanalysis,  a  correc- 
tion took  place  automatically. 

The  fundamental  principles  in  interpreting  dreams 
are  (1)  that  the  material  of  the  dream  is  taken  mainly 
from  recent  events,  (2)  that  every  dream  expresses 
the  fulfillment  of  a  wish  that  has  remained  unful- 
filled, and  (3)  that  the  language  of  the  dream  in  adults 
is  usually  symbolical  and  not  direct. 

In  children  the  language  is  not  symbolical,  and  the 
dream  shows  itself  at  once  as  the  expression  of  a 
wish.  My  niece,  twelve  years  of  age,  had  received  some 
chickens  which  rather  disappointed  her  on  account 
of  their  smallness;   the  next  morning  she  related  a 


108  STUTTERING   AND    LISPING 

dream  of  having  a  lot  of  fine,  large  Cochin-Chinas. 
Her  dream  had  fulfilled  her  unsatisfied  wish  of  the 
day  before.  In  adults  the  language  of  the  dream  is 
sometimes  also  direct.  It  is  not  unusual  for  my 
patients  to  report  that  they  dream  of  losing  the  paper 
given  them  to  record  dreams  on,  of  seeing  me  tell 
them  not  to  record  dreams,  etc.  Upon  being  told 
that  these  are  really  wishes,  they  confess  that  the 
task  of  recording  dreams  is  irksome  to  them. 

Nearly  always,  however,  the  language  of  the  dream 
is  symbolic,  and  the  patient  sees  no  meaning  in  it. 
Many  of  the  dreams  of  stutterers,  however,  have  a 
common  type. 

One  stutterer  dreamed  repeatedly  that  he  was  a 
great  social  success  at  parties,  that  he  was  a  friend  of 
the  King  of  England,  etc.  Another  one  thought  that 
he  and  a  friend,  playing  with  great  exhilaration,  had 
won  a  football  game  against  an  entire  college  eleven, 
Y  hereby  he  had  made  brilliant  runs  and  kicks  that 
had  brought  applause  from  the  grand  stand.  In  all 
such  dreams  the  stutterer  represents  himself  as  pos- 
sessing an  excess  of  coolness  and  self-confidence ; 
that  is,  he  puts  himself  into  possession  of  just  the 
qualities  he  lacks.     It  is  also  typical  of  stutterers' 


METHODS   OF   TREATMENT  109 

dreams  that  they  refer  to  their  relations  to  other 
persons. 

The  method  of  ^'running  associations"  referred  to 
above  is  intended  to  give  the  subconscious  an  oppor- 
tunity to  present  its  material.     Why  should  my  niece, 
in  the  dream  related  above,  have  thought  of  Cochin- 
Chinas?     She  was  induced  to  talk  about  chickens; 
before  long  she  came  out  with  the  memory  of  a 
former  home  where  she  had  seen  such  chickens.    The 
stutterer  who  won  the  football  game  was  asked  to 
let  his  thoughts  wander  freely.     He  gave  the  asso- 
ciations :    ''football  game  —  crowd  —  class  —  Medi- 
cal   School  —  professor  —  Roosevelt  —  campaign," 
all  of  which  referred  to  incidents  where  he  had  had 
difficulty  in  speaking.     The  friend  who  played  with 
him  was  indistinctly  seen;    when  asked  what  he 
thought  of  when  the  word  ''friend"  was  spoken, 
he  replied,  "doctor."     The  meaning  of  the  dream 
was    at    once    clear.     With   his    friend    the    doctor 
to  help  his  speech  he  was  able  to  face  a  formidable 
crowd  or  a  difficult  situation  and  achieve  success 
and  applause.     The  wish  that  reahzed  itself  in  the 
dream  was  that  with  the  doctor's  help  he  might  get 
over  his  stuttering  and  be  able  to  conduct  himself 


110  STUTTERING  AND   LISPING 

in  his  speech  so  briUiantly  that  he  could  success- 
fully face  his  class  and  all  other  situations  that 
might  present  themselves. 

As  the  peculiarities  and  deformities  of  character 
of  the  stutterer  present  themselves  spontaneously 
in  the  dreams  and  in  the  discussions,  he  learns  to  see 
them  himself  and  gradually  to  correct  them.  This 
is  usually  more  efficacious  than  any  attempt  of  the 
physician  to  directly  point  out  the  defects.  The 
psychanalysis  need  not  go  so  far  as  in  the  treat- 
ment of  hysteria ;  it  has,  moreover,  the  distinct  ad- 
vantage that  every  such  revelation  of  his  own  charac- 
ter to  himself  produces  greater  ease  in  the  stutterer's 
speech.  The  results  of  the  treatment  show  them- 
selves gradually  and  steadily. 


PART   11 
LISPING 

CHAPTER  I 

INTRODUCTION 

Owing  to  the  fact  that  the  symptoms  are  so  often 
the  same  or  similar,  it  is  convenient  to  include  under 
^ lisping"  several  different  speech  disorders  whose 
characteristics  he  essentially  in  defects  of  enuncia- 
tion. We  may  distinguish  four  different  Usping 
disorders ;  namely,  negligent  Hsping,  organic  Usp- 
ing, neurotic  lisping,  and  cluttering. 

The  use  of  the  word  ^4isp"  in  this  larger  sense 
is  in  accord  with  the  original  Anglo-Saxon  ^'whsp" 
and  with  the  use  in  literature.  ^^To  lisp  in  num- 
bers" (Pope)  refers  to  baby  talk,  of  which  neghgent 
lisping  is  the  survival. 

In  discussing  individual  sounds  it  is  desirable  to 
have  an  alphabet.  The  following  list  gives  the  chief 
sounds  of  English  with  a  phonetic  alphabet  in  paren- 
theses ( )  to  indicate  them,  and  with  examples  in 

111 


112 


STUTTERING   AND   LISPING 


ordinary  spelling.  In  the  discussion  of  lisping  1 
have  as  far  as  possible  avoided  the  phonetic  alpha- 
bet and  have  given  illustrations  in  ordinary  English 
spelUng. 


Phonetic 

Example 

Phonetic  • 

Example 

Letter 

Letter 

a 

ah,  father 

f 

/erry 

ae 

fare 

V 

z;ery- 

e 

date 

s 

so,  dose 

€ 

debt 

z 

.2;orie,  do2!e 

9 

her,  further 

J 

show 

A 

much 

3 

Sizure 

i 

peel 

6 

thin 

I 

pill 

« 

thine 

O 

pole 

c 

chew 

0 

Taul,  poll 

J 

jew 

u 

pool 

y 

yon 

u 

pidl 

m 

mow 

p 

par 

n 

no 

b 

hSLT 

q 

sing 

t 

toe 

J 

row 

d 

doe 

1 

low 

k 

car 

w 

woe 

g 

go 

h 

hoe 

The  variations  from  the  type  are  manifold,  but 
finer  distinctions  are  not  useful  here.  We  may  note, 
however,  that  the  first  half   of  the   diphthong   in 


INTRODUCTION 


113 


'^  fly  "  is  not  exactly  the  sound  indicated  by  (aj  but  a 
somewhat  different  one  that  we  may  indicate  by  (a). 


Fig.  39.  —  Median  section  of  the  organs  of  enunciation  and  phonation. 

The  various  sounds  are  produced  by  different  ad- 
justments of  the  vocal  organs.  Fig.  39  gives  a  median 
section  through  the  vocal  organs  of  the  head.     The 


114 


STUTTERING  AND   LISPING 


larynx  is  just  in  front  of  the  backbone  and  just  be- 
low and  behind  the  tongue.  The  roof  of  the  mouth 
is  formed  by  the  hard  palate,  at  the  rear  of  which 
is  the  velum  (soft  palate)  with  the  uvula  hang- 
ing   down.      The    nasal    cavity   extends   from   the 

nostrils  in  front  to 
the  pharynx  in  the 
rear.  Median  sections 
for  the  typical  English 
sounds  are  given  in 
Plates  I,  II,  and  III 
at  the  end  of  the  vol- 
ume. The  heavy  }ine 
at  the  larynx  indi- 
cates that  the  larynx 

Fig.  40. — Artificial  palate.  j       •  j-i. 

A  thin  plate  of  aluminum  is  made     VlbratCS      durmg      the 
for  the  roof  of  the  mouth.     It  is  ^+"U,1++rl* 

dusted   with    chalk  and  placed  in     SOUnd  ;  tnC  dOttea  ring 
the  mouth.    When  a  sound  is  pro- 
duced, the    tongue    wipes    off  the 
chalk  where  it  touches  the  palate. 


indicates  that  it  does 
not. 


When  the  mouth  is  widely  opened  and  properly 
illuminated,  the  positions  of  the  tongue  and  velum 
can  be  observed  in  a  mirror. 

The  contact  of  the  tongue  with  the  hard  palate 
in  producing  sounds  may  be  studied  by  palatography. 


INTRODUCTION 


115 


The  tongue  or  the  roof  of  the  mouth  may  be 
painted  with  ultramarine  water  color.  The  desired 
sound  is  spoken.  The  contact  of  the  tongue  with 
the  palate  is  seen  where  the  color  is  wiped  off. 

For  more  exten- 
sive recording  a  cast 
of  the  roof  of  the 
person's  mouth  is 
made,  either  with 
dental  modeling 
compound  or  with 
plaster.  From  this 
a  dentist    makes  a 

thin  artificial  palate     Fig.  41.  —  Palatogram  for  the  vowel  "ee." 

The  black  areas  show    where  the 
or     dental     plate    of  tongue  touched  the  palate. 

vulcanite,  aluminum,  silver  or  gold  (Fig.  40). 

An  artificial  palate  may  be  made  of  eight  or  ten 
sheets  of  wet  tissue  paper.  A  sheet  is  pressed  over 
the  mold ;  paste  is  spread  over  it,  and  another  sheet 
is  pressed  on,  etc.  It  is  carefully  worked  into  the 
depressions  of  the  mold  by  the  fingers.  When 
it  is  perfectly  dry,  it  is  coated  with  black  varnish. 

For  an  experiment  the  inner  surface  of  the  artificial 
palate  is  slightly  oiled  and  sprinkled  with  powdered 


116  STUTTERING   AND   LISPING 

chalk.  It  is  iiiKserted  in  the  mouth ;  the  sound  is 
spoken  and  the  artificial  palate  is  removed.  The 
parts  touched  by  the  tongue  appear  black,  the  chalk 
having  been  removed  where  the  tongue  touched  it. 
The  results  may  be  photographed,  painted  on  a  cast, 
or  sketched  on  paper.  Such  a  palatogram  on  a  cast 
for  the  vowel  ^'ee"  is  shown  in  Fig.  41.  Palato- 
grams  for  typical  English  sounds  are  given  in  Plate 
IV  at  the  end  of  the  volume. 

The  sounds  (a,  se,  e,  e,  i,  i,  o,  o,  u,  u)  are  termed 
^^  vowels."  For  all  of  them  the  lips  are  more  or  less 
opened.  When  the  vowel  ^^ah"  is  sung  before  a 
mirror,  the  velum  can  be  seen  to  rise  upward  and 
backward;  this  clears  the  passage  from  the  throat 
to  the  mouth,  and  cuts  off  the  passage  from  the  throat 
to  the  rear  of  the  nasal  cavity.  The  velum  rises 
likewise  for  all  the  vowels.  If  the  finger  is  placed  on 
the  front  of  the  neck  over  the  larynx  while  the  vowels 
are  sung,  the  vibrations  of  the  voice  will  be  felt  dur- 
ing all  of  them.  Observations  in  a  mirror  show  that 
the  vowels  differ  in  the  positions  of  the  lips  and 
tongue.^ 

1  It  has  been  proven  that  the  laryngeal  adjustments  also  differ 
for  the  various  vowels.  Scripture,  Researches  in  Experimental 
Phonetics,  116,  Carnegie  Institution  Publication  No.  44. 


INTRODUCTION  117 

The  ^'occlusives  "  (p,  b ;  t,  d ;  k,  g)  are  made  by  clos- 
ing the  mouth  passage  at  some  place.  The  closure 
occurs  at  the  lips  for  the  '4abial  occlusives"  (p,  b). 
The  closure  at  the  front  of  the  tongue  for  ft,  d)  and 
at  the  back  of  it  for  (k,  g)  causes  them  to  be  called 
''front"  and  "rear  lingual  occlusives,"  respectively. 
In  English  an  occlusive  usually  ends  with  release  of 
the  contact  before  the  breath  ceases,  producing  a 
sharp  puff  of  air.  The  English  occlusives  are  there- 
fore termed  "explosives." 

For  the  sounds  (f,  v;  s,  z;  J,  3;  6,  S)  a  channel  per- 
mits a  current  of  air  to  issue  with  a  rushing  or  hissing 
effect ;  they  are  called ' '  fricatives. ' '  The  sounds  (f ,  v) 
are  "labial  fricatives";  (s,  z;  J,  3;  6,  S)  are  "front 
lingual  fricatives"  ;  there  are  no  rear  lingual  frica- 
tives in  English. 

For  (j)  the  tongue  leaves  a  moderately  large 
opening  at  the  front ;  for  (1)  the  opening  is  at  the 
sides ;  for  (w)  the  small  opening  is  at  the  lips ;  the 
opening  is  not  so  large  as  in  the  vowels  and  not 
so  small  as  in  the  fricatives ;  no  term  for  grouping 
these  sounds  has  yet  been  introduced.  For  (h) 
there  is  a  narrow  opening  at  the  glottis. 

For  the  sounds  (JS,  j)  there  is  occlusion  by  the  front 


118  STUTTERING   AND    LISPING 

of  the  tongue  during  the  first  portion  and  a  rush  of 
air  through  a  narrow  channel  for  the  second  portion. 
It  has  been  proposed  to  consider  them  as  double 
sounds  (tj,  d3),  but  experimental  records  show  vital 
differences ;  the  two  elements  of  occlusion  and  fric- 
tion are  so  closely  united  in  (c,  j)  as  to  make  them 
single  sounds.  Moreover,  the  positions  of  the  tongue, 
jaw,  and  lips  are  different  from  those  of  (t,  d)  and 
(J,  3),  as  may  be  seen  in  Plate  I. 

During  (m,  n,  ry)  the  nasal  passage  is  open,  hence 
the  term  ^^  nasal." 

During  (p,  f,  t,  k,  s,  J,  6)  the  larynx  does  not  vi- 
brate;  these  consonants  are  called  ^^  surds."  Dur- 
ing (b,  V,  d,  g,  z,  3,  6)  the  larynx  vibrates ;  they  are 
called  ''sonants."  The  sounds  (m,  n,  r),  J,  w)  are 
nearly  always  sonants.  The  sound  (h)  is  usually 
surd,  but  sometimes  sonant.  All  whispered  sounds 
are  surd. 

The  vertical  diagrams  and  palatograms  for  the 
consonants  are  given  in  Plates  I,  II,  and  III  at  the 
end  of  this  volume.  The  dotted  line  over  the  larynx 
indicates  that  it  does  not  vibrate  for  the  surds;  the 
heavy  line  indicates  that  it  does  for  the  sonants. 

The  breath  indicator  shown  in  Fig.  42  may  be  used 


INTRODUCTION 


119 


1 

r' 

^^^w  ,  j3 

f 

• 

^ 

fl 

1 

\    'l^^^l 

1 

Fig.  42.  —  Candle  flame  indicator  used  for  the  mouth. 

According  as  air  issues  or  does  not  issue  from  the  mouth,  the  candle 
flame  bends  or  stands  upright. 

to  illustrate  the  properties  of  many  sounds.  The 
tube  from  the  mouth  is  directed  against  a  candle 
flame.    When  the  vowels  are  spoken  into  the  mouth- 


120 


STUTTERTNO   AND    LISPING 


Fig.  43.  —  Tambour  indicator  used  for  the  nose. 

The  indicator  is  made  from  a  thistle  funnel  covered  with  rubber. 
A  piece  of  card  hangs  in  front  of  the  rubber  and  is  fastened  to  it  by 
glue  or  wax.  Air  issuing  from  the  nose  moves  the  card  flap.  A 
mouthpiece  may  be  used,  as  in  Fig.  42. 

piece,  the  flame  is  deflected.  The  same  is  true  of  the 
fricatives.  During  the  occlusives  the  flame  is  up- 
right, but  it  is  sharply  deflected  by  the  explosions 
at  the  ends  of  the  occlusions. 


INTRODIK^TION  121 

Tho  ])reatli  indicalor  shown  In  Fig.  43  consists  of 
a  thistle  funnel  over  the  top  of  which  thin  rubber 
is  stretched  and  tied.  A  strip  of  visiting  card  is  cut 
across  and  joined  with  tissue  paper  to  make  a  hinge. 
A  piece  of  wax  holds  one  piece  of  the  card  to  the  fun- 
nel, while  the  other  one  hangs  in  front  of  the  rubber 
membrane.  A  drop  of  paste  connects  the  hanging 
flap  to  the  membrane.  The  funnel  is  connected  by 
a  rubber  tube  to  a  nasal  tip.  When  any  air  issues 
from  the  nose,  it  goes  into  the  funnel  and  moves  the 
rubber  membrane  ;  the  movement  is  indicated  by  the 
flap.  This  indicator  can  be  used  with  a  mouth- 
piece like  the  one  in  Fig.  42. 

The  examination  of  a  person  with  incorrect  enun- 
ciation should  cover  the  typical  sounds.  Each  con- 
sonant may  be  spoken  with  the  vowel  ''  ah  "  after 
it  or  in  some  typical  word;  the  list  on  p.  112  may 
be  used. 

Although  the  patient  may  be  able  to  speak  the 
separate  sounds  correctly,  he  may  mumble  and  con- 
fuse them  in  ordinary  talking. 


CHAPTER  II 


NEGLIGENT   LISPING 


In  order  to  produce  speech  sounds  like  those  of 
other  people  an  individual  must  hear  correctly  what 

other  persons  say;  in 
order  to  move  his 
speech  organs  correctly 
he  must  feel  their 
movements  and  hear 
the  sounds  he  himself 
produces.  By  long  ex- 
perimentation the  in- 
fant acquires  the  art 
of  talking  like  other 
people.  If,  however, 
the  child  is  careless  or 
negligent  in  his  obser- 
vation of  the  speech  of 
other  people  or  himself,  he  fails  to  produce  the  sounds 

properly  and   he   does  not  even  notice  his  errors. 

122 


Fig.  44.  —  Lip  position  for  "f"   and 
"v." 

The  lower  lip  is  brought  against 
the  upper  teeth. 


NEGLIGENT    LISPING 


123 


These  are  the  characteristics  of  ''  neghgent  Usping," 
or  ''functional  Hsping."  The  essential  pathological 
fact  is  mental  carelessness.  The  cure  consists  in 
teaching  the  patient  to  carefully  correct  his 
faults. 


If  the  cure  is  neg- 
lected, some  children 
may  become  nervous 
about  their  speech  and 
turn  into  neurotic  lisp- 
ers  (see  Chapter  IV) ; 
as  this  trouble  is  a 
much  more  serious  one, 
it  is  not  safe  to  neglect 
negligent  lisping.  In 
other  children  the  ridi- 
cule of  their  comrades 
and  the  reproof  at 
home  may  produce  a 
true  hysteria  with  symptoms  of  disturbance  of  mind 
(emotional  complexes)  and  body  (loss  of  pharyn- 
geal and  corneal  reflexes,  etc.). 

Occasionally  a  defective  speech  organ  produces  a 
defective  sound  (organic  lisping),  which  so  confuses 


Fig.  45.  —  Lip  position  for  "w." 

The    lips  are  projected    slightly 
forward  with  a  small  opening. 


124 


STUTTERING   AND    LISPING 


the  child  that  all  his  sounds  become  incorrect  (negli- 
gent lisping). 

Lip  Defects 

Some  persons  use  '^v"  for  ^^w,"  as  in  ^'Samivel 
Veller"  for  "Samuel  Weller."     For  "v"  the  lower 

lip  should  be  against 
the  upper  teeth  (Fig. 
44);for  "w"  the  two 
lips  are  brought  near 
each  other  (Fig.  45). 
To  correct  the  fault, 
the  patient  is  told  to 
say  ''well,  word, 
wind,"  etc.  Just  as 
he  starts  to  say  ''veil, 
vord,  vind,"  etc.,  his 
lower  lip  is  pressed 
down  with    a   finger 

Fig.  46.  —  Lip   position   for   correcting 

"w"  into  "v."  or  a  stick;  he  is  thus 

The  lower  lip  is  caught  between 
the   teeth  when  a    "w"    is  to    be      forCed  tO  Say  "w"  iu- 
spoken. 

Stead  of  "v.'' 
The  opposite  defect  may  occur.     The  patient  says 
"werry"  for  "very,"  "wote"  for  "vote,"  etc.     He 


NEGLIGENT    LISPING 


125 


is  told  to  bite  his  lower  lip  when  trying  to  say  words 
beginning  with  ^'v"  (Fig.  46). 

The  use  of  ^^p"  for  ^^f"  and  ^^b"  for  ^V  arises 
from  pressing  the  lips  too  tightly  together.     A  thick 

Fig.   47.  —  Palato-         Fig.   48.  —  Palato-  ^^^^^^^ 


gram    for    for- 

gram for  back- 

Fig. 49.  — Palato- 

ward   "t"  and 

ward  "t"   and 

gram  for  "k" 

"d." 

"d." 

and  "g." 

stick  or  a  finger  is  stuck  between  the  lips  so  that  they 
cannot  close  tightly.     This  produces   the  fricative 


Fig.  50.  —  Mouth  dia- 

Fig. 51.  —  Mouth  dia- 

gram for  "t"  and 
"d." 

The  front  of  the 

gram  for  "k"  and 

<*  „   )> 

g. 

The  back  of  the 

tongue    is    raised 

tongue    is     raised 

against    the    hard 

against  the  velum 

palate  just  behind 

at  the  rear  of  the 

the  teeth. 

-    hard  palate. 

126  STUTTERING  AND   LISPING 

sound.    The  differences  are  also  learned  by  observa- 
tion of  the  instructor  and  looking  at  one's  self  in 


Fig.  52.  —  Mouth  record  of  "water"  spoken  normally. 

The  sudden  and  complete  cutting  off  of  the  breath  during  the  "t" 
and  the  strong  explosion  at  its  end  are  evident. 

a  mirror.     The  differences  may  be  made  apparent  by 
a  breath  indicator  (p.  119). 

The  substitution  of  ^^s"  and  ^^z"  for  '^f "  and  ^'v" 
rests  upon  the  likeness  in  the  fricative  sound.   Atten- 


FiG.  53.  —  Mouth  record  of  "water"  spoken  by  a  lisper. 

Instead  of  the  breath  being  cut  off  for  the  "t,"  there  is  only  a  faint 
diminution ;  the  sound  is  like  "  th  "  instead  of  "  t."  The  laryngeal 
vibrations  are  continued  from  "  a "  without  stopping  through  the 
"th"  into  the  vowel  "er."  A  correct  "t"  has  no  laryngeal  vibra- 
tions. 

tion  is  called  to  the  fact  that  in  words  with  'T^  and 
'V  the  lips  are  closed,  while  in  the  words  with  "s" 
and  ''z"  they  are  open. 


NEGLIGENT   LISPING  127 

Defects  oft,''  "d"  ''k/'  and  "g''  (t,  d,  k,  g) 
For  "t''  and  ''d"  the  front  of  the  tongue  is  raised 
against    the    palate    just    behind    the   teeth    (Figs. 
47,  48,  50);   for    '^k"    and    ^'g"    the  rear   part    is 
raised  (Figs.  49-51).     For  'H"  and  ^^d"  it  is  usual 
to  turn  the  tip  of  the  tongue  upward  as  in  Fig  47. 
Many  persons   form  the  ''t"  and  ''d"  by  putting 
the  tip  farther  back  against  the  palate  (Fig.   48). 
One  defect  in  'H"  and  ''d"  is  failure  to  completely 
close  the  air  passage  by  the  tongue.     An  additional 
defect  for  "f'  is  failure  to  stop  the  laryngeal  vibra- 
tions when  the  sound  occurs  between  vowels.     The 
two  defects  are  illustrated  by  graphic  records  taken 
with  the  mouth  recorder  (Fig.  7). 

A  normal  curve  of  ''water"  as  recorded  by  the 
graphic  method  is  given  in  Fig.  52.  A  slight  rush  of 
the  breath  is  followed  by  a  nearly  straight  line  indi- 
cating the  faint  sound  of  ''w."  The  mouth  opens 
rather  suddenly  and  the  line  rises  as  the  vibrations 
of  ''a"  rush  out.  The  breath  is  cut  off  completely 
during  the  "V  As  the  tongue  releases  the  "t/'  sl 
strong  puff  of  air  occurs  and  the  line  goes  sharply 
upward.  The  record  ends  with  the  final  vowel.  The 
record  for  a  lisper  is  shown  in  Fig.  53.     Where  there 


128  STUTTERING    AND    LISPING 

should  be  a  straight  line  with  an  explosion  for  the  'H," 
there  are  strong  vibrations  with  only  a  slight  sinking 
of  the  line.  This  shows  that  the  larynx  did  not  stop 
during  ''t"  and  that  the  tongue  did  not  close  the 
air  passage.  The  patient  says  ^'wather"  (wo'Sa) 
instead  of  ''water"   (woto). 

The  chief  fault  is  the  failure  to  close  the  tongue 
tightly  at  the  front.  Ordinarily  it  is  sufficient  to 
explain  to  the  patient  that  there  are  two  classes 
of  sounds  called  ''occlusives"  and  "fricatives."  For 
the  occlusives  the  current  of  air  passing  through 
the  mouth  must  be  cut  off  at  some  point ;  for  the 
occlusives  "t"  and  "d"  the  tip  of  the  tongue  must 
close  firmly  against  the  palate.  When  it  does  not 
do  so,  it  produces  the  fricative  sound  "th."  The 
other  defect,  namely,  keeping  the  larynx  vibrating, 
disappears  when  the  "t"  is  carefully  made. 

A  frequent  defect  among  children  is  the  use  of  "t  ' 
for  "k, "  as  in  "tandy"  for  "candy."  Sometimes 
this  substitution  occurs  regularly ;  usually  it  is 
only  in  some  words.  The  patient  who  says  "tandy" 
will  usually  say  "car"  correctly.  That  is,  although 
he  is  able  to  make  the  sound  of  "k,"  he  replaces  it 
by   'H"   in   some  words  through  pure  negligence. 


NEGLIGENT    LISPING  129 

Both  "f  and  '^k"  are  occlusives,  that  is,  the  cur- 
rent of  air  is  shut  off  entirely  during  the  sound  ;  the 
patient  does  not  take  the  trouble  to  distinguish  be- 
tween them.  A  similar  substitution  is  made  of  ''d" 
for  ^^g"  (hard  ^^g"  asin  ^^go").  The  child  says  " Div 
me  sum  tandy."  The  cure  may  begin  by  having 
him  open  his  mouth  wide  and  say  ^^ca-ca-ca-candy." 
He  looks  into  the  mouth  of  the  instructor  and  sees 
that  the  tongue  rises  in  the  back ;  looking  into  a 
mirror,  he  learns  how  his  own   tongue  is  to  move. 

It  is  sometimes  useful  to  push  the  point  of  the 
tongue  back  and  down  by  a  stick  (tongue  depressor) 
when  a  word  beginning  with  ^^k"  or  ^'g"  is  used. 
The  child  cannot  say  "t'^  or  ^^d,"  and  he  is  forced 
to  raise  the  tongue  at  the  back. 

Similar  procedures  are  used  if  '^k"  and  '^g"  are 
replaced  by  other  sounds. 

Defects  of  "s''  and  "z''  (s,  z) 

To  produce  ^^s"  or  " z^'  the  front  of  the  tongue 
is  raised  against  the  hard  palate  behind  the  teeth, 
while  a  small  channel  is  left  in  the  middle  so  that  a  jet 
of  air  is  blown  through.  A  palatogram  is  shown  in 
Fig.  54,  a  mouth  diagram  in  Fig.  56.     Every  modi' 


130  STUTTERING   AND    LISPING 

fication  in   the  shape  of  this  channel  changes  the 
character  of  the  hissing  sound.     For  ^^z"  the  vocal 

a  cords  vibrate;  for  ^^s"  they  do  not. 
The  hiss  for  the  ^^s"  is  frequently 
too  weak,  the  channel  being  too  wide. 
The  defect  is  corrected  by  using  greater 
Fig.  54.  — Paiato-  prcssure  of  the  tongue.     When  the  hiss 

gram  for  "s" 

and  "z."         is  too  sharp,  relaxation  is  taught. 
The  most   frequent   defect   is   that  whereby   the 
patient  says  ^Hoap,"  ^Houp/'  ''tun/'  etc.,  for  ''soap," 
*'soup/'    "sun,"  etc.,  or   "dink"   for 
"zinc."     Instead  of  a  rush  of  air  dur- 
ing "s"  there  is  complete  stoppage; 
the  "fricative"  sound  is  turned  into 
an  "occlusive."     Through  neghgence  ^     ..      ^  ,  , 

the  person  presses  his  tongue  against        ^ram  for  oc- 
cluded '  s 

the   palate   a    trifle    too    hard   when        and  "z." 

The  tongue 

saying  "s"  or  "z."     This  closes  the        touches     the 

palate  over  a 

opening    that   is    necessary   for    "s"        larger      area 

than    in    Fig. 

(Figs.  54,  56),  and  makes  an  occlusive        54.  Thechan- 
(Figs.  55,  57)  that  sounds  like   "t."        too    much 
This  may  be  shown  by  graphic  records 
(p.  22)  by  means  of  the  mouth  recorder  (Fig.  7).     A 
normal  record  for  "sun"  is  shown  in   Fig.  58;    a 


NEGLIGENT    LISPING 


131 


record  with  the  occlusive  instead  of  the  '^s"  is  given 
in  Fig.  59. 

With  a  small  rubber  bulb  placed  between  the  front 

of   the   tongue   and 

the  palate  (Fig.    5), 

and     connected     to 

a  registering   appa- 
ratus   (Fig.   3),  the 

force  of  the  pressure 

of  the  tongue  can  be 


t?     -a      AT    .uA-     recorded. 

Fig.  o6.  —  Mouth  dia- 
gram for  "s"  and   occluded 


Ug„ 


For     an   Fig.     57. —  Mouth 
diagram  for  oc- 


it  is 


The  front  of  the  greater  than  for  the 

tongue  rises  so  as 

to  form  a  narrow  ordinary  '^s"  or  for 

channel     at     the 

front  of  the  palate,    ''t"   (Fig.  60).      The 


eluded  "s"  and 
"z." 

The  channel 
of  Fig.  56  is 
closed  by  too 
much  pressure. 


occluded  ''s"  is  thus  not   the  same  as   a  'H";   it 


may  be   defined   as   an   ^^s"   made  with  excessive 
tongue  pressure  resulting  in  a  sound  like  ^^t." 

Treatment  by  having  the  patient  imitate  the  ''s" 
of  a  normal  person  usually  aggravates  the  defect; 
he  is  already  making  too  much  effort  with  his  tongue, 
and  the  more  he  tries,  the  greater  the  effort  he  makes. 
Sometimes  he  can  be  taught  directly  to  relax  the 
tongue,  but  this  rarely  succeeds. 


132 


STUTTERING  AND  LISPING 


Fig.  58.  —  Mouth  record  of  "  sun"  spoken  normally. 

The  record  was  made  as  shown  in  Fig.  7.  The  rising  line  registers 
the  air  issuing  during  "s";  this  is  followed  by  the  vibrations  for 
"u"and"n." 


Fig.  59.  —  Mouth  record  of  "  sun"  spoken  by  a  lisper. 

The  record  was  made  as  shown  in  Fig.  7.    The  straight  portion  of 
the  hne  shows  that  no  air  issued  during  the  attempt  at  "s." 


Fig.  60.  —  Tongue  record  for  occluded  "  s." 

A  record  by  the  method  of  Fig.  5  shows  that  the  pressure  of  the 
front  of  the  tongue  against  the  palate  is  small  for  "  s,"  larger  for  "  t," 
and  largest  for  occluded  "  s." 

One  cure  consists  in  inserting  a  probe,  an  appli- 
cator, a  toothpick,  or  a  pencil  just  over  the  middle 
of  the  tongue  and  pressing  it  down  as   the  person 


NEOLKJEXT   LISPING 


133 


begins  to  speak  a  word  beginning  with  ''s"  (Fig. 
61).  He  cannot  close  the  passage  completely, 
and  instead  of  saying  "t'^  he  is  forced  to  say 
^^s."  This  catches  his  ear,  and  he  notices  the 
difference    in    sound. 


Constant  repetition 
enables  him  to  train 
his  tongue  in  the  new 
way. 

Another  cure  con- 
sists in  practicing  the 
patient  in  making  a 
sound  with  a  sharp 
hiss. 

For  other  cases  a 
breath  indicator 
(Figs.  42,  43)  is  ef- 
fective. 

Frequently  the  ''  s  " 
and  " z^^  are  made  with  channels  at  the  sides  instead 
of  the  front.  The  hiss  sounds  like  an  ^4"  ;  instead 
of  '^soap/^  '^soup/'  the  patient  seems  to  say  '^sloap'^ 
and  '^sloup."  The  defect  is  corrected  by  teaching  a 
correct    '^s,"  either  by  imitation  of  the  sound  as 


Fig.  61.—  Correcting  occluded  "  s  "  and 
"z." 

The  small  stick  over  the  front  of 
the  tongue  produces  the  channel 
necessary  for  "  s  "  and  "  z." 


134 


STUTTERING  AND   LISPING 


heard  by  the  ear  or  by  using  a  stick  over  the  middle 
of  the  tongue,  as  in  the  case  of  occlusive  ^^s"  and 
^^z";  the  patient  will  close  up  the  side  channel  as 
soon  as  one  is  made  in  the  middle. 

Sometimes  the  ^^s" 
and  ^^z"  are  made  in 
a  way  that  produces 
sounds  like  "sh.^^  For 
^^sh"  the  channel  in 
the  middle  of  the 
tongue  is  seen  to  be 
broader  and  differ- 
ently formed  when 
compared  to  that  for 
'^s."  The  cure  is 
often  brought  about 
by  using  a  probe  or 
a  stick  as  in  the  pre- 
vious case ;  the  irrita- 
tion makes  the  patient  narrow  the  channel.  Some- 
times it  is  necessary  to  train  the  patient  to  use 
^H"  instead  of  "s,"  and  then  to  correct  this  fault 
as  previously  described. 

Sometimes  a  ^Hh"  sound  is  used  for  ^^s"  and  "z,^^ 


Fig.  62.  —  Making  the  interdental  frica- 
tive. 

The  tongue  is  pushed  out  be- 
tween the  teeth.  The  sound  re- 
sembles that  of  "th." 


NEGLIGENT    LISPIXG  135 

The  patient  who  has  this  fault  usually  sticks  his 
tongue  between  the  teeth  for  ''s"  (Fig.  62),  mak- 
ing an  interdental  fricative  not  used  in  EngHsh. 
Sometimes  it  is  sufficient  to  show  him  that  people 
do  not  stick  their  tongues  out  that  wsiy.  He  then 
watches  his  own  tongue  in  a  mirror.  He  also  learns 
to  make  ''s"  with  the  teeth  tightl}^  closed.  A 
small  stick  can  also  be  used,  as  in  ''t"  for  ^'s." 

The  patient  who  uses  ''f "  for  ^'s"  is  satisfied  with 
the  fact  that  he  is  producing  a  fricative  sound;  he 
notices  no  difference.  He  must  be  taught  to  dis- 
tinguish between  the  two  kinds.  He  is  to  watch  his 
lips  in  a  mirror ;  he  sees  that  the  lower  lip  does  not 
close  against  the  teeth  for  ''s."  His  lips  may  be 
held  open  while  he  is  obliged  to  say  ''s." 

A  similar  case  is  that  where  a  guttural  fricative 
(like  the  German  '^ch"  in  ^'ich")  is  used  for  ''s." 
The  formation  of  ^'s"  is  to  be  explained  and  taught. 

Occasionally  an  utterly  different  sound,  such  as 
^^k,"  is  used.  If  the  correct  ''s"  cannot  be  taught 
directly,  the  "t^'  is  taught  and  then  this  corrected 
to  ^'s'^  as  described  above. 


136  STUTTERING  AND  LISPING 

Defects  of  "ch''  mid"j''  (c,j) 

The  sounds  ^^ch"  and  ^^j,"  as  in  '^church"  and 
^' judge/'  have  been  considered  as  consonantal  diph- 
thongs, each  made  up  of  two  sounds,  'H"  with  ^'sh'' 


Fig.  63.  —  Mouth  record  of  the  word  "  Mitchell." 

The  faint  vibrations  for  "m"  are  followed  by  stronger  ones  for  the 
vowel  "i."  The  air  current  is  cut  off  entirely  for  a  short  time  there- 
after ;  this  is  the  occlusion  for  the  sound  "ch"  ("tch").  Thereafter 
the  rather  quick  and  strong  rise  of  the  line  indicates  an  explosion  of 
special  form.     The  record  ends  with  the  vibrations  for  "  e"  and  "11." 

and  ^'d"  with  ^^sh."     Graphic  records  of  the  sounds 
^^ch"  and  ^^j"  have  proven  that  they  are  two  inde- 


FiG.  64.  —  Mouth  record  of  the  word  "nutshell." 

The  faint  vibrations  for  "  n  "  are  followed  by  stronger  ones  for  the 
vowel  "u."  The  air  current  is  cut  off  for  "t,"  which  has  no  explo- 
sion here.  This  is  followed  by  gradual  rise  of  the  line  for  the  frica- 
tive sound  "sh."  The  word  ends  with  the  vibrations  for  "e"  and 
"11." 

pendent  sounds.^  A  record  of  the  word  ^^ Mitchell" 
(Fig.  63)  shows  the  sound  ''ch'^  —  spelled  ^Hch"  here 
—  to  be  an  occlusion  followed  by  an  explosion  of  a 

1  Winifred  Scripture,  "The  sounds  of  'eh'  and  *j,"'  Popular 
Science  Monthly,  October,  1911. 


NEOLIGEXT   LISPING  137 

special  form  that  is  never  seen  in  any  other  typical 
sound.  A  record  of  the  word  ''nutshell"  (Fig.  64) 
shows  an  occlusion  for  the  'H"  without  any  explo- 
sion, followed  by  a  long  rush  of  air  for  the  ''sh." 
The  sound  ''ch"  (c)  is  thus  quite  different  from  the 
combination  of  the  sounds  ''tsh"  ft  J;. 
The  difference  between  the  two 
sounds  can  be  shown  in  another  way. 
A  palatogram  for  ''ch"  or  ''j"  shows 
that   the  tongue  touches  the  palate  ^lo.  65.  —  Paiuto- 

gram  for    'r-h 

farther   back  than  for   "t''   or   ^^i,"        and  "j." 

The    tongue 

and   that    it    covers   a   bigger   space        touches  the 

palate    over    a 
(Fig.  65).  larger    area 

than   for    "t" 

The    mouth    diagram    is    given    in        and"d." 
Fig.    66.     The    front    of    the    tongue    touches    the 
palate  rather  far  back ;    the  lips  are  somewhat  pro- 
truded.    The  differences  from  "t/'  ''d"  are  marked 
(Fig.  50). 

The  establishment  of  the  fact  that  ^^ch"  and  "j" 
are  individual  sounds  is  analogous  to  the  proof  fur- 
nished long  ago  that  the  two  forms  of  ''sh"  (J,  3) 
are  individual  sounds,  and  not  compounds  of  ^^s" 
and  ^^h." 

The  typical  defects  are  of  two  kinds.     In  one  the 


138  STUTTERING    AND    LISPING 

tongue  presses  too  tightly  against  the  palate,  in  a  way 
similar  to  that  for  an  occluded ''s"  (p.  130).  The 
sound  is likea  ''V  for  ''ch"  anda  ''d"  for  ^^  j."  In  the 
other  the  tongue  is  not  pressed  tightly  enough.  This 
produces  a  sound  resembling  ''  sh." 
The  treatment  for  the  former  is 
similar  to  that  for  the  occluded  ''  s  " 
(p.  132),  the  purpose  being  to  obtain 
relaxation  of  the  tongue.  For  the 
latter  the  patient  is  told  to  press 
t^  j  the  tongue  more  strongly. 

"""gram  t"" ch'"      W^cfe  of  "u  "  and  "ru,"  (n,  q) 

and  "j." 

The  tongue       For  ''u"   the  tongue  takes  the 

touches  the  palate 

over  a  larger  area   Same  position  as  for  ^H  "  and  ^'d'' 

than  for  "t"  and 

"d";  the  lips  are   (Fig.    50),    but  the  velum   is   not 

projected  forward,  . 

and  the  teeth  are  raiscd  (Fig.  67).     For  ''ng,"asm 

rather  close.  .         ,,    ,i        ,  .,.  •      ^'^        / 

smg,  the  tongue  position  is  like 
that  for  ''k"  (Figs.  49,  51)  with  the  velum  not 
raised  (Fig.  68). 

The  use  of  ^'m"  for  ^^n"  (the  lip  nasal  for  the 
front  tongue  nasal)  is  corrected  by  observation  in  a 
mirror,  by  making  the  patient  open  his  lips  while 
saying  ''n,"  etc.     The  use  of  'H"  or  ^'d"  for  '^n" 


NEGLIGENT    LISPING  139 

is  a  velar  defect;  it  is  corrected  by  exercises  in 
raising  the  velum  as  described  under  Velum  Defects 
below.  The  sound  ''n,"  namely,  the  nasal  with 
forward  contact  of  the  tongue,  is  sometimes  used 
for  ''ng,"  the  nasal  with  rear  contact,  as  in  ''good 


Fig.  67.  —  Mouth  dia-                         p^^  gg.  —  Mouth  dia- 
gram for  "n."  ^^^^  for  "ng." 

The      tongue  ^j^^     ^,^^^^     is 

touches  the  palate  ^^^^^^^    ^^^    ^^^ 

at  the  same  place  ^^^y.  ^^  ^^^  ^^^^^ 
as    for     "t"     and 
"d."     The  velum 


is  raised  slightly  to 
meet  it. 


is  lowered. 

mornin"  instead  of  ''good  morning."  The  confu- 
sion is  aided  by  the  lack  of  any  English  letter  for  the 
sound  "ng."  The  correction  is  made  by  calling  the 
patient's  attention  to  the  difference  and  by  making 
him  open  his  mouth  widely  while  making  the  "ng" 
in  such  words  as  "sing,"  "ring,"  "bring,"  "calling," 
etc.     The    "ng"    in   words    like    "finger"    consists 


140 


STUTTERING    AND    LISPING 


of  the  two  sounds  '^n"  and   "g''   and  not  of  the 
single  sound  ^'ng"  (q). 


Defects  of  the  Two  Forms  of  "sh^^  (J,  3) 

The  two  sounds  indicated  by  ''sh"  are  made  by 
raising  the  front  of  the  tongue  so  as  to  cut  off  a'l 

breath     except 

through  a  small 

channel    (Figs.    69, 

70).     For  (J)  (^'sh" 
Fig.  69.  — Paiato-  as  in  ''azure")   the 

gram  for  "sh." 

The    tongue  larynx  vibrates ;  for 

touches  the  pal- 
ate  along   the   (3)    ^sh"    as    in 

sides  and  leaves 

a  larger  opening    ^'show")     it     doCS 

in     front    than 

for"s."  not. 


Fig.  70.  —  Mouth  dia- 
gram for  "sh." 

The  tongue  is 
raised  against  the 
palate  over  a  broad 
area  further  back 
than  for  "s."  The 
channel  is  longer. 


Sometimes   the   pressure   of   the 
tongue  is  too  weak ;    the  channel  is 
too   large,    and    the   ^'sh"    sounds 
faint  and  hollow.     The  defect  can  be  corrected   by 
emphasizing  the  tongue  pressure. 

Sometimes  the  contact  is  so  weak  and  incorrect 
that  the  resulting  sound  is  more  like  'Hh."  The 
tongue  is  to  be  pressed  with  more  force. 

When  the  sound  '-'s"  is  made  instead  of  *'sh,"  it 


NEGLIGENT    LISPING 


141 


indicates   that   the  child  does  not  properly  distin- 
guish between  them. 
He  is  to  be  drilled 
in  careful  pronunci- 
ation of  words  with 

Fig.   71.  — Palato-    sUCh  SOUuds. 
gram  for  "th." 

The  tongue       It  occasioually 

touches  the 

palate  in  front  happens   that    ''f"  is 

over    a    broad 

space  so  hghtly  USed  f  Or  ' '  sh. "      Just 

thataires-  .,     ,,„..„         ,,     ,, 

as  with '^f"  for  ^^s" 


capes. 


(p.  135),  he  is  taught  to  distinguish 
them,  and  his  lips  may  be  held 
apart.  For  the  rare  ^H"  for  ^^sh" 
a  procedure  like  that  of  ^H"  for  ^^s"  may  be  tried 


Fig.  7.  .  —  Mouth  dia- 
gram for  "th." 

The  front  of  the 
tongue  is  raised 
against  the  palate, 
but  a  very  wide 
channel  is  left. 


Defects  of  the  Two  Forms  of  "th''  (B,  S) 

In  producing  the  two  sounds  indicated  by  ^Hh" 
the  front  of  the  tongue  is  raised  against  the  palate 
(Figs.  71,  72),  the  tip  touching  so  lightly  that  the 
air  escapes  over  it.  For  ^Hh"  as  in  'Hhin"  the 
larynx  is  silent;  for  ^^th''  as  in  'Hhine"  it  pro- 
duces a  tone. 

It  is  very  common  for  children  to  use  "f  and  ^'d'' 
for  'Hh";    thus,  they  say  ''tin,"  ''tree/'  'Humb'' 


142 


STUTTERING   AND   LISPING 


for  ^Hhin,"  'Hhree/'  'Hhumb/'  and  ^^dis/'  '^dough/' 
'^dee"    for    '^this/'    ^Hhough,"    'Hhe."     It    is    like 

the  language  of  the 
loafer  or  the  tough: 
' '  Are  you  wid  me  ?  Yes, 
trou'  tick  and  tin." 

Fig.   73. —  Mouth  record   of   "thin"  The  def ect  ariseS  frOHl 
spoken  normally. 

The  rising  line  shows  that  dur-  pressiug  the   tOUgUe    tOO 

ing  "th"  the  air  issues  from  the  •   i        i 

mouth  in  a  steady  stream.     The  tightly,    With    the    result 
small    vibrations    are    from    the 

vowel  and  "n."  that    uo    air    cau    issue 

from  the  mouth ;   this  makes  an  occluded  ^Hh"  that 
sounds  like  a  'H"  or  a  '^d." 

A  mouth  record  (Fig.  7)  of  the  word  "  thin ''  spoken 
normally  is  given  in  Fig. 
73;  it  is  very  clear  that 
air  issues  from  tjhe  mouth 
during  the  ' '  th . "  A  record 
of  the  same  word  spoken 
by  a  lisper  is  given  in  Fig. 
75;  the  first  sound  was 
evidently  an  occlusion 
with  an  explosion  similar 
to  the  first  sound  in    '4in "   (Fig.   74). 

The  cure  consists  in  inserting  a  probe  or  a  stick  at 


Fig.  74.  —  Mouth  record  of  "tin  " 
spoken  normally. 

The  straight  line  indicates 
the  occlusion  of  the  "t"; 
the  sharp  upward  movement 
is  the  result  of  its  explosion. 
The  small  vibrations  are  from 
the  vowel  and  "n." 


NEGLIGENT   LISPING 


143 


Fig.  75.  —  Mouth  record  of  "thin"  with  occluded  "th,"  by  a  lisper. 

The  sudden  depression  of  the  line  at  the  start  indicates  a  strong 
jerk  of  the  tongue  whereby  air  is  drawn  in  for  an  instant.  The 
straight  line  indicates  that  the  tongue  is  held  tightly  against  the 
palate.  The  sudden  upward  jerk  is  the  explosion  of  the  occluded 
"th."  The  occluded  "th"  is  longer  than  the  normal  "th"  or  "t"  ; 
this  is  a  result  of  the  excessive  effort.  Its  explosion  is  stronger  than 
that  of  "t." 


the  side  of  the  mouth 
above  the  tongue  (Fig. 
76) .  When  the  patient 
tries  to  say  'H/'  his 
tongue  is  pressed  down 
across  the  tip  and  he 
is  forced  to  say  "ihJ' 
It  is  also  useful  to 
teach  the  use  of  the 
interdental  fricative 
(p.  134)  as  a  substitute 
for  the  defective  "thJ' 
The  breath  indicator  is 
often  effective  (Fig.  42) . 


Fig.  76.  —  Correcting  occluded  "th." 
A  stick  is  held  across  the  front  of 
the  tongue,  so  that  it  cannot  be 
pressed  tightly  against  the  palate. 


144 


STUTTERING   AND    LISPING 


Children  often  use  ^^f"  and  ^^v"  for  'Hh/'  sub- 
stituting one  fricative  for  another.  The  defect 
is  explained  to  the  patient.  He  is  to  observe  in  a 
mirror  that  for  words  like  ^Hhin,"  ^'thimble/'  ''this/' 
''though/'  etc.,  the  lips  remain  apart.     If  necessary, 


Fig.  77.  —  Mouth  record  of  front  rolled  "r"  by  an  American. 

The  larger  vibrations  result  from  the  flapping  of  the  tip  of  the 
tongue ;  the  very  fine  vibrations  are  the  record  of  the  laryngeal 
vibrations,  that  is,  of  the  tone  of  the  voice. 

the  lower  lip  may  be  held  down  by  a  stick  or  the 
finger. 

Defects  of  W  and  "Z"  (j,  1) 
The  original  sound  from  which  English  derives 
its  "r/'  as  in  "run,"  was  the  rolled  or  trilled  "r, " 
which  is  indicated  phonetically  by  (r).  The  rolled 
"r,"  which  is  no  longer  used  in  English,  is  the  only  one 
in  German,  French,  Italian,  and  most  other  languages. 
To  produce  the  rolled  "r"  with  the  point  of  the 
tongue,  its  front  portion  is  pressed  against  the 
palate  tightly  except  at  the  point.     The  pressure  of 


NEGLIGENT    LISPING 


145 


the  breath  causes  the  point  to  flap.     A  mouth  record 
by  the  apparatus  shown  in  Fig.  7  is  given  in  Fig.  77. 

a  In  EngHsh  '^r" 
the  tongue  position 
is  the  same,  but  the 
point  is  held  away 
from  the  palate 
(Figs.  78,  79) ;  there 


Fig.    78.  —  Palato- 
gram  for  Eng- 
lish "r." 
The  side  and 


front    of    the  jg    j^o    flapping     or 

tongue    are 

raised;  the   roUiug.  A      mOUth 

channel  in  the 

middle  is  wider   rCCOrd  of  ''   SOrrOW  " 
than  for  "sh," 

but  not  so  wide  (Fig.  80)  shows  Small 

as    for    the 

vowels.  Vibrations     for    the 


^'  r  "  Uke  those  of  a  vowel 


Tig.  79.  —  Mouth  dia- 
gram for  "r." 

The  front  of  the 
tongue  is  raised 
against  the  palate, 
but  the  tip  does 
not  quite  touch  it. 


The  phonetic  letter  is  (a). 
In  large  cities  like  Berhn  and  Paris,  and  regularly 


Fig.  80.  —  Mouth  record  of  English  "r." 

The  record  is  of  the  word  "sorrow."  The  rising  line  at  the  start 
indicates  the  air  issuing  during  the  "s."  The  small  vibrations  are 
those  of  two  vowels  with  "r"  between  them.  The  vibrations  for 
''r"  do  not  differ  from  those  for  the  vowels  except  in  minor  details. 

in  Yiddish,  the  rolled  ^^r"  is  produced  by  forming 
a  groove  in  the  rear  of  the  tongue  in  which  the 


146 


STUTTERING   AND  LISPING 


uvula  is  allowed  to  rest.  The  breath  causes  the 
uvula  to  vibrate.  A  mouth  record  is  shown  in  Fig.  81. 
The  phonetic  letter  is  (r). 


Fig.  81.  —  Mouth  record  of  uvula  "r"  by  a  Parisian. 

The  larger  vibrations  result  from  the  flapping  of  the  uvula ;  the 
finer  ones  are  the  record  of  the  laryngeal  vibrations,  that  is,  of  the 
tone  of  the  voice. 

For  ^4"  the  tongue  is  tight  in  front  and  open  along 
the  sides  (Figs.  82,  83). 

The  most  com- 
mon defect  in  Eng- 
lish is  the  use  of  the 
easy  sound  ^^w"  for 


The  cure  con- 


FiG.  82.  —  Paiato-  the    difficult    sound 

gram  for  "1."      ^       ,, 

The    tongue       ^  • 
touches  the     .    ,        .  ...  . , 

palate    at    the  Sists    m    gettmg    the  Fig.  83.  -  Mouth  dia- 

front,     leaving   ,  '        +1.  '    U+  ^""^"^  ^""'^  "^•" 

tongue    in    the    right  The  front  of  the 

tongue  touches  the 

place  for  ''u.'      One        palate. 
method  is  to  teach  the  rolled  ^^r";    the  rolling  is 
to  be  done  with  the  tip  of  the  tongue.     When  the 
patient   can   talk  with   the  rolled   "r/^  he  simply 


free  passage  at 
each  side. 


NEGLIGENT   LISPING 


147 


drops  the  roll  while  using  the  same  tongue  position. 
When  the  person  cannot  get  the  tongue  right  for 
the  rolled 


"r;'  it 


is  useful  to  use  an- 
other sound  that 


requires  the  point     Fig.  84.  —  Rod  for  pushing  the  tongue.     The 
-         ,  rod  is  made  of  an  aluminum  applicator 

01      the      tongue  (twice  the  size  of  the  figure). 

against  the  palate.     For  example,  he  is  told  to  repeat 

''sun,  run,  sun,  run,'^ 
etc.,  or  'Hun,  run, 
tun,  run,"  etc. 

In  more  difficult 
cases  the  patient  ob- 
serves the  tongue  of 
another  person  say- 
ing "r."  He  finds 
that  it  touches  the 
teeth  along  the  sides, 
but  is  free  in  front ; 
this  is  particularly 
clear   when   the   ' '  r " 


Fig.   85.  —  Pushing     the     tongue     into 
position  for  "r." 

The  rod  pushes  the  front  of  the 
tongue  up  and  back. 


is  rolled.     With  a  mirror  he  tries  to  get  the  same 
position. 

The  instrument   shown  in  Fig.  84  is  made  by 


148  STUTTERING    AND    LISPING 

bending  a  light  wire  (aluminum  applicator).  With 
it  the  front  of  the  tongue  can  be  pushed  upward  and 
backward  into  the  position  for  ^'r"  (Fig.  85). 

Sometimes  '4"  is  used  for  '^r."  It  is  like  the 
Mongolian  lisp  used  by  the  Chinaman,  who  sa^^s 
'^Melican  man  here  light  away."  The  patient  is 
shown  that  for  "\^^  the  tongue  is  open  along  the 
sides  while  tight  at  the  tip.  The  action  is  thus 
the  rev^erse  of  that  for  ''r."  For  the  correction  of 
this  obstinate  defect  the  tongue  is  drawn  back  into  the 
mouth  so  that  it  cannot  be  released  at  the  sides ; 
the  point  is  turned  up.  A  flat  stick  or  a  small  rod 
(aluminum  applicator)  bent  to  the  form  shown  in 
Fig.  84  may  be  put  under  the  tongue  to  push  it 
back  and  up. 

Children  of  foreign -born  parents  sometimes  use 
the  lingual  or  uvular  rolled  '^r"  instead  of  the  smooth 
English  '^r."  Their  peculiarity  may  be  illustrated 
as  follows:  '^Rrrobert  makes  a  rrring  arrround  if 
or  ''RRRobert  makes  a  RRRing  aRRROund  it"  instead 
of  ''Robert,"  etc.  It  is  usually  sufficient  to  teach 
the  difference  by  ear  between  the  English  ''r"  and 
the  rolled  ''r. "  For  more  difficult  cases  a  breath 
recorder  (Fig.  7)  may  be  used  ;   the  indicator  makes 


NEGLIGENT  LISPING  149 

a  steady  movement  for  the  English  ^^r,"  while  it 
vibrates  heavily  for  the  rolled  ^^r." 

The  ^^r"  may  be  omitted  or  replaced  by  other 
sounds,  as  ^'n/'  ^H,"  'V/'  etc.  The  use  of  ^^w"  for 
^^r"  is  very  frequent;  the  child  is  sometimes  en- 
couraged to  say  ^^vewy,"  ^^pwetty,"  etc.,  because  it 
sounds  ^^cute."  Both  tongue  and  lips  take  the  posi- 
tions for  ^^w"  instead  of  those  for  "r''  (Plate  II). 
Even  when  the  tongue  is  in  the  position  proper  for 
^^r/'  the  lips  may  have  the  position  for  ^^w."  This 
makes  a  peculiar  ^^r"  with  a  ^^w"  tinge.  These  defects 
are  to  be  corrected  by  teaching  the  patient  to  make 
exaggerated  or  rolled  ^^r"s.  Words  are  recited  with 
exaggerated  ^^r"s,  rolled  and  not  rolled.  The  lower 
lip  may  be  held  down  to  hinder  the  ^'w"  move- 
ment. 

The  usual  defect  for  "V^  consists  in  the  use  of  an 
''r"  or  in  dropping  the  ^4."  In  both  cases  the  cure 
consists  in  imitation  or  in  explanation  with  observa- 
tion of  the  tongue.  In  order  to  enforce  the  fact 
that  the  tongue  must  touch  at  the  tip  for  ^4,"  it 
is  useful  to  draw  the  tongue  back  and  then  throw 
the  tip  sharply  into  place  against  the  palate  as  an 
initial  ^4 ''  is  to  be  pronounced. 


150  STUTTERING    AND    LISPING 

If  a  nasal  sound  is  used  for  ^'1, "  the  correction  is  to 
be  made  by  pinching  the  nose,  by  the  nasal  indicator, 
etc.,  as  described  under  ''Velum  Defects." 

Velum  Defects 

For  all  English  sounds  except  the  nasals  ''m,  n,  ng,'^ 
the  velum,  or  soft  palate,  must  rise  so  as  to  close 
more  or  less  completely  the  passage  from  throat  to 
nose.  When  this  is  not  done,  the  speech  has  a  dull, 
nasal  snorting  character. 

The  vowels  msiy  be  tested  b}^  the  following  list : 
for  ''ah"  (a),  "ah,  arm,  art";  for  (ae),  "at,  after, 
am";  for  "aye"  (e),  "aid,  ate,  ale";  for  "eh" 
(€),  "ebb,  effort,  egg"  ;  for  "ee"  (i),  "eel,  eat,  easy"  ; 
for  (i)  "it,  in,  ill";  for  "oh"  (o),  "old,  owe,  oak"; 
for  "awe"  (o),  "awe,  awful,  ought":  for  "oo"  (u), 
"fool,  boor,  tool"  ;  for  (u),  "full,  pull,  bull." 

The  occlusives  may  be  tested  by  the  words  "ape, 
pa,  upper ;  able,  bee,  obey ;  at,  tar,  utter ;  add,  do, 
odor ;  oak,  caw,  ochre ;  egg,  go,  ago." 

The  fricatives  may  be  tested  by  the  words  "eff, 
fare,  offer;  eave,  veal,  ever ;  ess,  see,  essay  ;  ease,  zee, 
easy;  shoe,  ash,  usher;  azure,  pleasure;  thin, 
oath,  ether ;  though,  bathe,  either," 


NEGLIGENT   LISPING 


151 


The  sounds  of  ''r"  and  "V  may  be  tested  by  the 
words  '^run,  arrow,  law,  ell,  fellow." 

If  the  velum  does  not  rise  during  the  vowels, 
they  have  a  nasal  character  reminding  one  of  the 


Fig.  86.  —  Recording  the  nasal  current  and  vibrations. 

A  small  glass  tip  is  inserted  into  one  of  the  nostrils.  Currents  of 
air  and  vibrations  from  the  nose  pass  down  the  rubber  tube  to  the 
small  recording  tambour,  whose  lever  traces  a  line  on  the  recording 
surface. 

French  nasal  vowels.  If  it  does  not  rise  during  '^s," 
that  sound  appears  like  a  nasal  snort.  For  the  oc- 
clusives (p,  b,  t,  d,  k,  g)  the  lips  or  the  tongue  close  the 
air  passage  in  front  and  the  velum  closes  the  nasal 
passage;    the  air,  which  accumulates  under  some 


152  STUTTERING  AND  LISPING 

pressure,  is  released  by  the  lips  or  the  tongue ;  this 
causes  a  slight  puff  or  explosion  from  the  mouth.  If 
the  velum  is  dropped  before  the  release,  the  explosion 


Fig.  87.  —  Nasal  record  of  "sun"  spoken  normally. 

occurs  through  the  nose,  producing  peculiar  snorting 
sounds  for  ^^p,"  "h;'  "t;'  "d,''  "k/'  and  ^^g." 

Graphic  records  may  be  obtained  by  the  arrange- 
ment shown  in  Fig.  86.     For  example,  the  nasal  rec- 


FiG.  88.  —  Nasal  record  of  "sun"  with  relaxed  velum. 

ord  of  ^'sun"  with  correct  ''s"  (Fig.  87)  shows  no 
emission  of  air  during  "s/'  that  with  nasalized  '^s'^ 
(Fig.  88)  shows  a  strong  snort.  The  snorting  '^  s  '^ 
is  what  has  been  described  as  ^^  nasal  sigmatism^' ;  the 
other  snorting  sounds  have  not  been  specially  named. 
Sometimes  it  is  sufficient  to  explain  these  principles 
to  the  patient  and  let  him  feel  the  improper  nasal 
breathing  on  the  back  of  his  hand.  A  tissue  paper 
flag  (Fig.  89)  or  a  light  piece  of  cotton  is  also 
effective. 


NEDLICiEXT   LISPFNC!  153 

It  is  often  v(  ry  effective  to  use  a  breath  indicator 
which  shows  when  air  issues  from  the  nose  (Fig.  43). 

The  patient  must  learn  to  make  all  the  vowels  and 
the  proper  consonants  without  letting   air   escape 


Fig.  89.  —  Tissue  paper  indicator. 

The  passage  of  breath  through  the  nose  or  the  mouth  moves  the 
piece  of  paper. 

from  the  nose.     This  he  must  do  in  continuous  speech 
also. 

The  muscles  that  press  the  velum  against  the  rear 
of  the  pharynx  can  be  strengthened  by  a  velar  hook 
(Fig.  90)  made  of  a  rubber  penholder  whose  end  is 
softened  in  hot  water  and  bent,  or  of  a  bent  laryngeal 
electrode.     The  hook  is  inserted  behind  the  velum 


154  STUTTERING  AND   LISPING 

and  the  vowels  are  spoken  or  sung  while  the  hand 
pulls  on  the  handle  of  the  hook  (Fig.  91). 

Very  effective  is  the  application  of   a  laryngeal 
electrode  with  a  very  mild  faradic  current  to    the 


Fig.  90.  —  Velar  hook. 

velum.     The   slight    shock   induces   the  person   to 
draw  the  velum  up. 

An  appeal  to  the  ear  may  be  made  by  using  the 
nasal  tip  and  rubber  tube  shown  in  Fig.  86  with  the  free 
end  placed  to  the  ear.  When  the  velum  is  properly 
raised  during  ''a/'  '' s,"  ''papa/'  etc.,  very  little  is 
heard  in  the  ear.  When  the  velum  is  not  raised, 
the  sound  through  the  tube  is  very  loud.     The  tube 


NEGLIGENT    LISPING 


155 


is  placed  to  the  patient's  ear  and  the  instructor  puts 
the  tip  to  his  nose,  while  he  pronounces  the  words. 


Fig.  91.  —  Velar  hook  in  position. 

The  hook  has  been  placed  behind  the  velum,  which  is  raised  against 
a  slight  resistance  from  the  hand. 

Then  the  tip  is  transferred  to  the  patient's  nose  so 
that  he  can  listen  to  himself. 

Larynx  Defects 

The  use  of  surd  ''s"  (as  in  '^sun")  for  the  sonant 
''s"  (as  in  ''does"  or  ''zone")  sometimes  occurs. 
Such  a  patient  pronounces  "lies"  and  "doze"  as 
if  they  were  "Hce"  and  "dose."     He  is  taught  the 


156  STUTTERING  AND   LISPING 

difference  between  surd  and  sonant;    he  puts  his 
finger  over  the  larynx  (Adam's  apple)  and  feels  it 


Fig.  92.  —  Mouth  record  of  "dog." 

The  record  was  taken  with  the  apparatus  shown  in  Fig.  7.  The 
straight  line  at  the  beginning  represents  the  stoppage  of  breath 
during  "d."  The  following  vibrations  are  those  of  the  vowel.  The 
faint  vibrations  where  the  line  begins  to  sink  are  those  during  the 
occlusion  of  "  g."  Strong  vibrations  appear  at  the  end,  that  is,  during 
the  explosion  of  "g." 

vibrate  while  he  sings  or  speaks  a  prolonged  vowel 
with  a  ^^z"  (as  in  ^^does"  or  '^zone''). 


Fig.  93.  —  Mouth  record  of  "dok." 

The  record  differs  from  that  in  Fig.  92  in  having  no  vibrations 
during  the  sound  after  the  vowel,  namely,  during  "k." 

Similar  confusion  may  occur  with  the  other  sounds ; 
^'t"  may  be  used  for  "d,^'  ^^k"  for  "g,'^  etc.,  and  like- 
wise the  reverse. 

The  most  common  trouble  is  that  the  larynx  stops 
vibrating  before  the  sonant  is  really  finished.  Thus, 
the  person  appears  to  say  ^^dok''  instead  of  ^^dog''; 
in  reality  the  last  sound  was  half  ^^g"  and  half  ^^k," 


NEGLIGENT   LISPING  157 

and  he  said  "dogk."  Mouth  records  of  the  three 
cases  are  given  in  Figs.  92,  93,  94.  The  trouble  can 
usually  be  corrected  by  training  the  ear. 

General  Indistinctness 

The  negligence  may  go  so  far  that  the  patient 
speaks  in  a  generally,  slurred  manner.     Ordinarily 


Fig.  94.  —  Mouth  record  of  "dogk." 

There  are  faint  vibrations  after  the  vowel,  showing  that  the  sound 
began  as  "g"  and  not  as  "k"  ;  these  die  away  and  none  are  found 
at  the  time  of  the  explosion,  showing  that  the  sound  ended  in  "k." 

this  is  corrected  by  having  him  repeat  sounds,  words, 
and  sentences  after  a  careful  speaker.  The  following 
points  are  to  be  especially  noticed. 

The  sounds  ''p,  b,  t,  d,  k,  g"  are  produced  with  the 
lips  or  tongue  stopping  the  air  passage.  When  the 
stoppage  is  released,  the  air  comes  out  with  a  slight 
puff  or  explosion.  When  the  air  pressure  is  allowed 
to  fall  before  release  of  the  lips  or  the  tongue  no 
explosion  occurs.  This  is  the  normal  pronunciation 
in  French  ;  in  English  it  indicates  negligence. 


158  STUTTERING  AND  LISPING 

A  graphic  record  (Fig.  7)  of  the  normal  ^^p  "  (Fig.  95) 
shows  the  sharp  explosion  at  the  end  of  the  occlusion. 


Fig.  95.  —  Mouth  record   of   "apa"   with   the   explosion  of   "p"   well 
marked. 

The  record  was  taken  with  the  apparatus  shown  in  Fig.  7.  The 
waves  at  the  beginning  are  those  of  the  first  vowel.  Then  follows 
the  straight  line  for  the  occlusion  of  "p."  The  sharp  upward  move- 
ment of  the  line  is  the  result  of  the  explosion  of  "p."  Thereafter 
follow  the  vowel  waves. 

A  record  where  the  explosion  is  omitted  is  shown  in 
Fig.  96. 

The  cure  consists  in  training  the  patient  to  ex- 
plode his  ''p"s,  ^H"s,  etc.,  so  that  the  explosion  is 


Fig.  96.  —  Mouth  record  of  "apa"  with  no  explosion  of  "p." 

The  record  is  the  same  as  in  Fig.  95  without  the  sharp  upward 
movement  of  the  line.     The  "p"  had  no  explosion. 

quite  audible.  The  breath  indicators  shown  in  Figs. 
42,  43  with  a  mouthpiece  are  most  effective.  The 
patient  must  learn  to  make  all  his  occlusives  with 
marked  explosions. 


NEGLIGENT    LISPING  159 

The  ''s"  and  other  sounds  are  often  made  too 
weakly.  The  patient  must  learn  to  hiss  the  ^'s" 
strongly  and  to  make  each  sound  with  sufficient 
energy  to  cause  it  to  be  heard  distinctly.  Some- 
times the  nasal  sound  ''n"  is  systematically  too 
weak.  It  is  corrected  by  speaking  and  reading  with 
prolonged  ^'n"s. 

Vowels  or  consonants  are  often  slurred  over  too 
briefly.  The  training  consists  in  reading  and  speak- 
ing with  the  vowels  exaggerated  in  length. 

For  general  indistinctness  it  is  useful  to  speak  and 
spell  words  backward  over  a  private  telephone 
wire  or  to  a  person  so  far  away  that  there  is  diffi- 
culty in  understanding.  The  patient  may  prac- 
tice repeating  words  from  a  dictionary,  making,  for 
example,  at  one  time  air  the  '^s"s  prominent,  at 
another  all  the  ^H"s,  etc.;  such  combinations  as 
^'tw,"  ^'tr,"  ^'str,"  etc.,  require  special  attention. 
Such  sentences  as  ^' Peter  Piper  picked  a  peck  of 
pickled  peppers,"  ''Round  the  rough  and  rugged 
rock  the  ragged  rascal  ran,"  ''Shall  she  sell  sea  shells 
by  the  seashore,"  "Tired  Tommy  tripped  his  toes," 
etc.,  are  useful. 

The  higher  degrees  of  indistinctness  found  where 


160  STUTTERING   AND   LISPING 

the  intellectual  development  begins  to  be  slightly  de- 
fective are  to  be  treated  by  the  following  system : 

Tongue  gymnastics  are  introduced.  They  include, 
(1)  putting  out  and  pulhng  in  tongue ;  (2)  moving 
it  from  side  to  side  ;  (3)  holding  it  out  while  2,  3,  etc., 
are  counted ;  (4)  turning  up  the  tip  of  the  tongue 
to  the  palate  (with  fingers  if  necessary).  Similar 
exercises  are  performed  in  advancing  the  lips,  bit- 
ing them,  pouting,  grinning,  and  moving  the  lower 
jaw. 

Respiration  exercises  may.  include  blowing  up 
bags,  blowing  out  candles,  blowing  bubbles,  etc. 

The  articulation  exercises  are  to  be  based  on  the 
principle  that  the  child  is  to  see  how  the  teacher 
makes  each  sound;  he  hears  the  sound  and  is  then 
to  feel  his  own  movements  and  see  them  in  a  mirror 
while  he  hears  himself  make  the  same  sound.  Thus, 
after  seeing  the  action  of  the  teacher's  lips  for  "f " 
and  ''v"  he  watches  his  own  lips  in  a  mirror.  To 
distinguish  between  ^^f"  and  ^^v"  he  puts  his  hand 
over  the  teacher's  larynx  and  feels  that  the  vibrations 
are  lacking  in  ''f"  and  present  in  ^^v";  then  he 
feels  his  own  larynx.  The  lip  and  tongue  positions 
for  the  other  consonants  are  taught  similarly.     The 


NEGLIGENT    LISPING  161 

emission  of  the  breath  during  ''h"  and  the  fricatives 
may  be  felt  by  the  hand  held  in  front  of  the  mouth 

Careful  drill  in  pronouncing  words  and  sentences 
can  be  carried  out  in  connection  with  reading  exer- 
cises. 

The  training  of  the  intellect  should  be  carried  on 
at  the  same  time.  As  speech  is  most  closely  con- 
nected with  thinking,  the  most  efficacious  method  is 
to  make  the  speech  training  the  center  of  the  entire 
instruction. 


CHAPTER  III 

ORGANIC     LISPING 

^^ Organic  lisping"  is  the  term  that  may  be  ap- 
pUed  to  such  speech  defects  as  arise  from  anatomi- 
cal defects  of  the  vocal  organs. 

The  defective  speech  is  usually  a  great  drawback 
to  the  patient's  career.  It  sometimes  leads  to  fur- 
ther troubles.  One  boy  whose  enunciation  of  '^s" 
and  ^'z"  was  defective  on  account  of  overshot 
jaw  had  his  ideas  of  speech  so  confused  that  he  had 
failed  to  correct  the  infantile  ^H"  for  ^^k"  ('Handy" 
for  ''candy"),  although  he  could  make  such  sounds 
perfectly.  Moreover,  the  defect  had  caused  him  so 
much  mental  distress  and  strain  that  he  enunciated 
his  sounds  with  strongly  contracted  muscles, 
whereby  they  were  indistinct.  He  thus  had  all 
three  kinds  of  lisping :  organic,  negligent,  and  neu- 
rotic  (Chapter  IV). 

Lisping  from  Hare  Lip  or  from  Feeble  Lips 

The  former  requires  the  surgeon.     The  latter  may, 

in  some  cases,  be  aided  by  massage,  electricity,  and  lip 

162 


ORGANIC   LISPING 


163 


gymnastics.     The  lip   gymnastics  include   specially 

pressing  them  tightly  together,  holding  them  tightly 

while  the  breath  is  pressed 

against    them,    pouting, 

puckering,    etc.      If    the 

lips  are  weak  on  account 

of     muscular     dystrophy, 

all    such    treatment    must 

be  avoided. 


Lisping  from  Tongue  Defects 

When  the  tongue  is  too 
thick,  too  small,  too 
clumsy,  or  injured,  the 
resulting  inaccuracies  may 
be  mitigated  by  careful 
gymnastics  (p.  160)  and 
training  by  means  of  mir- 
ror, palatograms  (p.  114), 


Fig.  97.  —  Hemiatrophy  of   the 
tongue. 

Degeneration  of  the  nerve 
centers  had  caused  one  side 
of  the  tongue  to  become  much 
smaller  and  weaker.  This 
caused  the  patient  to  lisp. 
The  lisping  had  produced 
such  a  condition  of  embar- 
rassment and  fear  that  she 
was  considered  back- 
ward,  although  really  per- 
fectly normal  mentally. 


etc. 

Hemiatrophy  of  the  tongue  (Fig.  97)  shows  itself 
in  smallness  of  one  side  of  the  tongue,  in  grooves  in 
the  surface  and  in  fibrillary  twitchings.  The  speech 
is  usually  correct,  but  not  always  so.     The  speech  of 


164  STUTTERING   AND    LISPING 

one  girl  of  fifteen  was  so  indistinct  that  she  could 
not  get  along  in  school  and  was  considered  mentally 
dull.  The  correction  and  scolding  at  school  and  by 
the  mother  had  produced  intense  depression.  The 
cause  was  a  hitherto  unobserved  hemiatrophy  of 
the  tongue  which  made  it  difficult  to  use  the  tongue 
properly  (organic  lisping)  ;  this  had  so  confused  her 
that  she  made  all  sounds  indistinctly  (neghgent 
lisping). 

A  stuttering  boy  of  eight  years  was  found  to  have 
imperfect  enunciation,  due  to  confused  habits  of 
enunciation  arising  from  weakness  of  one  side  of 
the  tongue.  The  physical  defect  had  thus  produced 
organic  lisping,  which  had  in  turn  produced  negli- 
gent lisping.  The  embarrassment  and  shame  had 
produced  not  only  severe  stuttering,  but  also  a  serious 
deformity  of  character. 

Lisping  from  Tongue-Tie 

When  the  frenum  of  the  tongue  is  too  short,  it 
prevents  the  tongue  from  rising  sufficiently  in  front 
to  cut  off  all  the  air  except  what  passes  through  a 
small  channel  to  make  the  ^'s"  sound  (Fig.  56). 
The  sound  actually  produced  is  more  like   'Hh"; 


ORGANIC    USPING  165 

e.g.  ''people  tbay  I  lithp,  but  I  don't  pertheive 
it."  If  the  person  can  project  the  tip  of  the  tongue 
beyond  the  teeth,  the  tongue  is  free  enough  for  cor- 
rect speech. 

To  cut  the  frenum  the  region  is  thoroughly  co- 
cainized ;  an  incision  is  made  with  aseptic  scis- 
sors;  the  membranes  are  then  torn  slightly  further 
by  the  fingers  wrapped  in  gauze.  A  too  deep  in- 
cision risks  cutting  large  blood  vessels. 

In  older  people  the  lisp  may  still  remain  as  a  habit. 
It  should  then  be  treated  as  in  the  case  of  ''t"  for 
''s"  (p.  130). 

There  is  an  antiquated  belief  that  tongue-tie 
causes  stuttering.  It  cannot  do  so  directly,  but  I 
have  had  cases  where  the  lisping  due  to  tongue-tie 
had  made  the  person  so  nervous  that  he  had  become 
a  stutterer  (p.  43). 

Lisping  from  Jaw  and  Tooth  Defects 

Overshot  and  undershot  jaws  are  due  mainly  to 
irregular  development  of  the  teeth.  The  undershot 
jaw  occurs  also  with  the  disease  akromegaly.  In  ex- 
cessive cases  of  overshot  or  undershot  jaw  the  pro- 
jection may  be  so  great  that  the  lips  do  not  close 


166  STUTTERING   AND    LISPING 

properly  for  ''£/'  '^v,"  ^^p,"  "b,"  '^m,"  and  several  of 
the  vowels.  In  these  and  similar  cases  it  is  frequently 
difficult  to  adjust  the  tongue  quite  correctly,  especially 
for  ' '  s . "  With  strongly  undershot  j  aw  the  ' '  s  "  sound 
may  be  produced  as  the  tongue  moves  to  its  posi- 
tion to  make  a  ^H";  'Hool"  sounds  like  ^^ stool." 
When  the  upper  front  teeth  project  much  beyond  the 
lower  ones  it  is  frequently  difficult  to  adjust  the 
tongue  so  that  the  jet  of  air  strikes  the  lower  teeth 
correctly  for  "s"  (Fig.  56)  ;  the  sound  is  rather  like 
'^sh."  The  procedure  is  like  that  for  the  similar 
cases  in  negligent  speech. 

The  gaps  left  by  extracted  teeth  often  affect  the 
"s"  in  ways  difficult  to  remedy  except  by  insert- 
ing artificial  teeth. 

Sometimes  a  canine  tooth  is  bent  inward  in  such 
a  way  as  to  hinder  the  tongue  in  making  ^H";  a 
slight  ''s"  sound  precedes  the  ''t." 

For  many  jaw  and  tooth  defects  the  most  impor-' 
tant  therapeutic  procedure  is  orthodontism.  If  the 
child  is  under  sixteen  years  old,  he  should  be  put  in 
the  care  of  an  orthodontist.  Older  cases  are  usually 
hopeless. 


OROANIC    LISPING  107 

Lisping  from  High  Palatal  Arch 

The  defect  mainly  affects  the  ^'s"  ;  the  person  has 
difficulty  in  getting  the  tongue  properly  against  the 
palate  to  produce  the  small  channel.  Sometimes  he 
lets  the  air  escape  at  the  sides.  Sometimes  the  at- 
tempt to  press  the  tongue  up  tightly  leads  to  a  strong 
spasmodic  pressure  at  every  ^^s."  One  such  pa- 
tient with  the  ''s"  spasm  was  often  supposed  to  be  a 
person  who  stuttered  only  on  '^s."  In  one  case  the 
patient,  eleven  years  old,  had  given  up  all  effort  at  us- 
ing the  tongue  for  "s,''  replacing  it  by  a  pause  filled 
by  a  cramp  in  the  larynx.  He  pronounced  ''sink" 
apparently  like  ''ink"  ;  in  reality  the  pronunciation 
was  ('ink),  where  (')  indicates  the  glottal  catch. 
The  distortion  of  speech  caused  by  the  omission  of 
the  "s"  had  produced  so  much  trouble  that  the  boy 
had  acquired  the  strained,  hoarse  voice  and  the  sad 
face  of  a  stutterer.  The  defect  can  be  cured  or 
alleviated  by  careful  attempts  to  get  the  proper 
position.  The  spasmodic  cases  are  helped  by  train- 
ing in  soft  and  relaxed  speaking.  With  the  patient 
just  mentioned  who  always  omitted  the  "s, "  the  cure 
consisted   in   teaching    him   to   use   "ts"    for   "s," 


168  STUTTERING    AND    LISPING 

whereby  he  would  say  ' '  tsoup  "  f or ' '  soup . "  As  soon 
as  the  habit  was  formed,  he  dropped  the  "f  and 
retained  the  "sJ^ 

Lisping  from  Cleft  Palate 

When  the  velum  cannot  close  the  rear  passage 
through  the  nose,  all  the  sounds  except  nasals  are 
modified.  All  the  explosives  become  nasal  sounds, 
thus  '^p"  and  '^b"  become  ''m,''  ^'d"  becomes 
^^n,"  ^'g"  becomes  ^^ng,"  ''t"  and  "k"  become  surd 
^^n"  and  ^'ng,"  "s"  becomes  a  snort,  etc.  The 
vowels  are  all  nasal. 

After  the  velum  has  been  closed  by  operation, 
there  may  be  little  or  no  ability  to  raise  it  into  place 
across  the  pharynx.  Its  muscles  can  be  strengthened 
by  the  velar  hook  (p.  154).  Exercises  can  be  devised 
for  teaching  the  use  of  the  velum,  such  as  blowing  out 
a  candle,  playing  a  mouth  harmonica,  etc.  The  pa- 
tient does  them  at  first  while  holding  his  nose  closed 
with  his  fingers  ;  he  gradually  lessens  the  finger  pres- 
sure and  tries  to  substitute  velar  action. 

With  a  light  illuminating  the  interior  of  the  mouth, 
the  patient  observes  his  velum  in  a  mirror  as  he  sings 
^'ah"  on  a  low  note  and  then  on  a  high  note.     The 


OROANIC  LISPING  109 

velum  should  rise  for  both  notes,  more  for  the  higher 
ones.  Exercises  with  a  nasal  indicator,  tissue  paper 
flag,  etc.,  as  described  for  negligent  speech  (p.  153), 
aid  in  giving  the  proper  control.  Electrical  stimula- 
tion (p.  154)  is  often  very  effective. 

To  make  the  velum  rise  during  the  occlusives 
''p,  b,  t,  d,  k,  g"  they  are  pronounced  singly  and  in 
words  with  much  prolonged  occlusions  and  sharp 
explosions  at  the  end.  This  cannot  be  done  unless 
the  velum  is  properly  raised. 

Occasionally  some  of  the  velar  associations  are  very 
firmly  fixed  ;  special  devices  must  be  tried  to  break 
them  up.  Thus,  if  the  velum  persists  in  remaining 
down  for  ^'s,"  rods  of  various  sizes  may  be  placed 
over  the  tongue  (p.  143,  Fig.  76). 

The  loss  of  air  during  speech  with  a  cleft  palate 
naturally  leads  the  patient  to  take  breath  repeatedly 
within  a  sentence.  The  habit  may  persist  after  the 
operation ;  in  such  a  case  systematic  breath  exer- 
cises are  to  be  performed. 

The  great  effort  involved  in  speaking  with  a  cleft 
palate  may  lead  the  patient  to  overexertion  of  all  his 
speech  muscles ;  this  produces  a  grimacing  speech ; 
that  is,  the  muscles  of  the  face  overact.     This  is 


170  STUTTERING  AND   LISPING 

liable  to  persist  after  operation.  Relaxation  is 
taught  by  speaking  with  no  lip  motion  (as  in  ven- 
triloquism), by  singing,  by  exercises  in  melodious 
speech  (p.  74),  etc.  The  nervous  rapidity  of  speech 
requires  exercise  in  slowness  (p.  85). 

Lisping  from  Relaxed  Palate  after  Adenoids 

When  a  person  has  large  bunches  of  adenoids,  the 
closure  of  the  velum  is  made  against  them.  After 
they  have  been  removed,  the  velum  sometimes 
makes  the  same  amount  of  movement  as  before. 
This  leaves  a  gap  between  it  and  the  rear  wall  of 
the  pharynx  whereby  all  sounds  become  nasal. 
The  treatment  is  the  same  as  for  negligent  lisping 
(p.  150). 

Lisping  from  Obstructed  Nasal  Passages 

The  obstruction  deprives  the  nasal  sounds  more 
or  less  of  their  peculiar  ring.  Thus  ^^m"  sounds 
like^^b,"  ^^n"  like  ^^d,"  etc. 

This  condition  is  found  temporarily  in  severe 
colds ;  the  turbinates  in  the  nostrils  become  swollen 
and  the  nasal  cavities  are  more  or  less  closed.  Per- 
manently enlarged  turbinates  or  a  deflected  septum 
may  cause  a  similar  result.     With  large  adenoids  the 


ORGANIC^    LISPING  171 

passage  through  the  upper  pharynx  is  also  more  or 
less  obstructed. 

In  regard  to  speech  this  condition  is  the  opposite 
of  that  with  cleft  palate.  The  nasalization  from 
cleft  palate,  etc.,  consists  in  adding  nasal  tones  to 
sounds  where  they  do  not  belong.  The  denasaliza- 
tion  from  obstruction  consists  in  eliminating  nasal 
tones  when  they  should  be  present. 

No  special  voice  treatment  can  improve  this  condi- 
tion. For  colds  the  treatment  comprises  a  laxative 
(Seidlitz  powder,  citrate  of  magnesia),  cleansing  with 
antiseptic  sprays,  menthol,  coryza  wool,  etc.  Tur- 
binates, adenoids,  and  tonsils  are  referred  to  special- 
ists. 

Lisping  from  Defective  Hearing 

When  the  hearing  is  diminished,  the  child  may  fail 
to  grasp  the  finer  essentials  of  the  sounds.  In  mild 
cases  the  words  may  be  spoken  loudly  into  his  ear. 
Each  incorrect  sound  may  also  be  treated  separately 
as  described  in  the  chapter  on  Negligent  Lisping. 
Hearing  tubes  are  often  useful. 

In  more  severe  cases  lip  reading  should  be  taught 
in  a  way  somewhat  similar  to  that  for  deaf  children. 
By  feeling  the  teacher's  larynx  and  his  own  larynx 


172  STUTTERING    AND    LISPING 

and  by  listening  to  loud  tones  from  a  musical  in- 
strument the  child  gets  a  definite  idea  of  pitch  and 
of  the  adjustment  he  must  make  in  his  larynx  in 
order  to  produce  musical  sounds.  Then  by  watch- 
ing the  instructor's  face  and  by  looking  in  the 
mirror  he  learns  the  positions  of  the  lips  for  the 
individual  sounds.  In  a  similar  way  he  learns  the 
positions  of  the  tongue  fcr  "  t/'  "  d,"  "k/'  ''g/'  etc. 
The  positions  are  explained  by  the  diagrams  in  the 
plates  at  the  end  of  this  book.  The  tongue  posi- 
tions for  the  vowels  and  consonants  can  be  taught 
in  this  way. 

To  show  the  various  amounts  of  breath  that  issue 
during  the  vowels,  during  '*h/'  during  the  frica- 
tives, and  for  the  explosions  in  the  occlusives,  the 
patient's  hand  is  put  before  the  instructor's  mouth 
and  then  before  his  own.  A  slate,  a  cold  piece  of 
metal,  or  the  breath  indicators  described  on  pages 
119-121  can  be  used  for  the  same  purpose.  The 
presence  or  the  absence  of  nasality  can  be  shown 
in  a  sim  lar  way.  As  much  as  possible  the  child 
should  be  made  to  hear  all  the-  sounds.  When  such 
children  are  spoken  to,  they  should  be  able  to  see 
the  face  cf  the  instructor. 


CHAPTER  IV 

NEUROTIC    LISPING 

Patients  with  this  trouble  often  enunciate  sounds 
in  ways  that  resemble  negligent  speech.  The  failure 
of  the  methods  of  treatment  for  negligent  speech 
first  made  it  clear  to  me  that  this  disorder  was  of 
an  entirely  different  nature. 

Onepatient  used  "t"  for  ^^s,"  '^d"  for  ^^z,"  and 
'H"  and  ''d"  for  the  two  forms  of  ''th/'  the  tongue 
action  being  the  same  as  that  described  on  pp.  130, 
141.  The  patient  also  said  ^Hsoe"  instead  of  ''shoe." 
The  occlusives  (t,  d,  k,  g)  were  used  correctly,  but 
they  had  no  explosions  (p.  157).  This  was  quite  in 
contrast  to  the  false  occlusives  "t"  and  "d"  used 
for  "s,"  "z,"  "th,"  as  these   had  strong  explosions. 

The  patient  had  learned  to  talk  clearly,  but  at  four 
years  of  age  she  fell,  striking  her  head ;  she  remained 
unconscious  for  several  hours. 

A  few  days  afterwards  she  had  convulsions  ;   they 

were  frequently  repeated  till  the  age  of  six.     The 

173 


174  STUTTERING    AND    LISPING 

defect  in  speech  appeared  shortly  after  the  fall. 
She  now  has  a  tremor  of  the  entire  body  when  she 
attempts  to  speak.  There  is  also  a  tremor  of  the 
lips  during  ''p"  and  ^'b"  and  a  tremor  of  the  laryn- 
geal tone  when  a  vowel  is  sung.  It  is  hard  to  get  her 
to  produce  any  loud  or  long  sound ;  every  sound, 
even  a  simple  hiss,  is  produced  in  a  manner  indica- 
tive of  excessive  timidity  and  almost  of  fright.  These 
conditions  never  occur  in  cases  of  negligent  lisping ; 
the  patients  are  always  perfectly  cool  and  deliberate ; 
they  are  sluggish  and  phlegmatic  instead  of  nervous. 
The  similarity  of  her  mental  condition  to  that  of  the 
stutterer  is  evident. 

Graphic  records  were  made  of  the  air  current  for 
the  mouth  while  she  pronounced  some  sounds. 
The  arrangement  was  that  shown  in  Fig.  7.  When  a 
current  of  air  issues  from  the  mouth,  the  recording 
lever  rises  and  the  white  line  bends  upward.  A  de- 
scent of  the  hne  indicates  that  the  air  current  is 
diminished  or  cut  off.  The  decrease  of  the  air  current 
may  be  due  to  some  adjustment  of  the  tongue  or 
lips  or  to  a  cessation  of  the  pressure  from  the  chest. 

The  record  for  ''so"  in  Fig.  98,  spoken  by  a 
normal  person,  shows  that  the  air  current  steadily 


NEUROTIC   LISPING  175 

increased  during  the  first  part  of  the  ^^s"  and  then 
fell  somewhat.  The  small  waves  in  the  record  are 
due  to  the  laryngeal  vibrations;   in  '^so"  they  indi- 


FiG.  98.  —  Mouth  record  of  "so"  spoken  normally. 

The  first  part  of  the  line  registers  the  emission  of  the  air  during 
the  "s"  ;  it  rises  and  falls  smoothly.  The  small  vibrations  indicate 
the  waves  of  the  vowel. 

cate  the  vowel.  A  record  of  ^'so"  spoken  by  the 
patient  is  given  in  Fig.  99.  Instead  of  the  gradually 
increasing  and  diminishing  air  current  for  "s/^  the 


Fig.  99.  —  Mouth  record  of  "so"  in  neurotic  lisping. 

There  is  very  little  emission  of  the  air  for  the  "s"  ;  it  is  suddenly 
cut  short  by  complete  stoppage.  The  sudden  descent  of  the  line  at 
the  beginning  indicates  that  the  tongue  was  drawn  sharply  back. 
The  larger  waves  after  the  step  show  the  explosion  as  the  "t"-like 
sound  is  completed  by  the  release  of  the  tongue.  The  small  vibra- 
tions are  those  of  the  vowel. 

patient  merely  starts  the  current,  and  then  not  only 
cuts  it  off,  but  actually  causes  the  line  to  fall  below 
zero. 

For  the  normal  '^s"  the  tongue  is  placed  against 
the  roof  of  the  mouth  in  such  a  way  as  to  leave  a 


176  STUTTERING   AND    LISPING 

small  channel  in  the  middle,  through  which  a  jet  of 
air  is  directed  against  the  lower  teeth.  A  palato- 
gram  for  normal  ^'s"  is  shown  in  Fig.  54 ;  a  mouth 
diagram  of  the  position  of  the  tongue  is  shown  in 
Fig.  56.  During  the  normal  '^s"  a  current  of  air 
passes  to  the  recording  apparatus  and  causes  the  line 
to  rise  steadily. 

The  record  in  Fig.  99  indicates  that  the  patient 
pressed  the  tongue  so  hard  against  the  top  of  the 
mouth  that  she  closed  up  the  small  channel;  more- 
over, in  doing  this  she  made  such  a  forcible  move- 
ment of  the  tongue  that  air  was  actually  drawn  into 
the  mouth  for  an  instant.  The  sudden  rise  of  the 
line  indicates  that,  as  the  tongue  was  released  from 
its  place,  the  air  burst  from  behind  it  in  the  form  of 
a  sharp  puff,  or  explosion,  that  acted  like  a  blow 
on  the  recording  membrane.  The  sound  produced 
by  such  action  is  like  that  of  ^H."  Apparently  the 
patient  substituted  "t^'  for  ^^s.'^  In  like  manner 
for  ^'z'^  she  used  a  sound  like  ^^d.'' 

The  mechanism  for  the  defective  ^^s"  is  like  that 
for  occluded  ^^s"  (p.  130),  as  indicated  by  the  palato- 
gram  in  Fig.  55  and  the  mouth  diagram  in  Fig.  57. 
The   tongue  is   pressed   against   the  palate  harder 


NEUROTIC    LISPING 


177 


than   it  should   be ;   the   small   channel   is   thereby 
closed. 

The  graphic  record  of  '^silk"  (Fig.  100)  in  normal 
speech  shows  a  rather  long  emission  of  air  for  ^^s," 


Fig.  100.  —  Mouth  record  of  "silk"  spoken  normally. 

The  "s"  and  the  vowel  are  indicated  as  in  Fig.  98.  The  "1" 
is  represented  by  some  small  vibrations  at  the  end  of  the  vowel. 
The  "k"  begins  as  a  fall  in  the  line  due  to  cutting  off  the  breath  by 
the  tongue ;  it  ends  in  a  strong  upward  movement  due  to  the  ex- 
plosion as  the  tongue  is  released. 

followed  by  waves  for  the  vowel  and  "V^     The  '^k" 
begins  as  the  vowel  waves  cease ;   the  line  falls  be- 


FiG.  101.  —  Mouth  record  of  "silk"  in  neurotic  lisping. 

There  is  first  a  brief  intake  of  breath,  then  an  emission  of  breath 
corresponding  to  a  normal  "s."  This  is  followed  by  an  occlusion 
with  an  explosion.  The  sound  is  thus  partly  a  normal  "s,"  as  in 
Fig.  98,  but  mainly  an  occlusion  with  an  irregular  explosion.  The 
following  fine  vibrations  belong  to  the  vowel  and  "1."  The  "k"  is 
represented  by  a  straight  line  due  to  the  stoppage  of  the  breath  by 
the  tongue ;  the  abnorm  ality  is  shown  by  the  lack  of  an  explosion 
wave  for  the  "k,"  the  breath  being  stopped  before  the  tongue  is 
released. 

cause  the  current  of  air  is  cut  off  by  the  tongue ; 
the  explosion  of  the  '^k"  is  marked  by  the  sudden 
rise  of  the  line  at  the  close. 

N 


178  STUTTERING   AND    LISPING 

The  record  of  ^  ^  silk ' '  (Fig.  101 )  by  the  patient  shows 
a  sharp  inrush  of  air  followed  by  a  sudden  rise  of 
the  line  with  some  emission  of  air  thereafter.  The 
inrush  of  air  indicates  presumably  an  extremely 
brief  gasp  as  she  starts  the  tongue  movement.  The 
sudden  rise  shows  that  the  sound  ^'s"  is  begun. 
This  sound  is  at  first  a  true  though  faint  ''s/'  some 
air  being  emitted.     There  follows,  however,  a  sudden 


Fig.  102.  —  Mouth  record  of  "shoe"  in  normal  speech. 

The  emission  of  air  during  the  "sh"  is  similar  to  that  of  "s"  in 
Fig.  98.     The  record  ends  with  the  vowel  vibrations. 

drop  of  the  line  ;  this  shows  that  the  breath  has  been 
stopped  and  that  the  sound  has  become  an  occlusive. 
The  sudden  rise  of  the  line  thereafter  shows  that  this 
sound,  like  most  occlusives  in  English,  ended  with 
an  explosion.  The  first  part  of  the  sound  was  thus 
a  true  ^^s,"  while  the  second  was  an  occlusive  '^s" 
with  an  explosion.  The  remainder  of  the  record 
shows  the  waves  for  the  vowel  and  "V^  followed 
by  a  straight  line  for  the  occlusive  '^k."  The  ^'k'^ 
is  abnormal,  having  no  explosion. 

The  record  of  "shoe"  in  Fig.  102  is  that  for  normal 


NEUROTIC   LISPING  179 

speech.  It  shows  an  emission  of  breath  during  ''sh" 
similar  to  that  for  ^^s"  in  Fig.  98.  The  action  of  the 
tongue  for  ''sh"  is  like  that  for  ''s"  in  forming  a 
channel  through  which  the  air  is  directed.  A 
palatogram  for  normal  ^^sh"  is  given  in  Fig.  69; 
a  mouth  diagram  in  Fig.  70. 
A  record  of  neurotically  lisped   '^shoe"   is   given 


Fig.  103.  —  Mouth  record  of  "shoe"  in  neurotic  lisping. 

The  straight  line,  the  sudden  fall,  and  the  strong  waves  show  that 
the  tongue  closed  the  mouth,  was  sharply  drawn  back,  and  was  then 
released  with  a  strong  explosion.  Then  followed  a  faint  breathy 
sound  like  a  weak  "s."  The  record  ends  with  the  vowel  vibrations. 
To  the  ear  the  word  sounded  somewhat  like  "tsoe." 

in  Fig.  103.  There  is  a  sudden  intake  of  breath ;  this 
is  abruptly  released.  This  indicates  that  at  the 
start  the  tongue  was  placed  tightly  against  the  palate. 
As  it  was  released  to  form  '^sh/'  it  permitted  a  sHght 
puff  of  air  to  pass.  This  would  produce  a  short 
"t.'^  The  ^'f  was  followed  by  a  rather  faint  emis- 
sion throughout  the  ''sh."  There  was  no  occlusion 
during  or  after  the  emission  ;  otherwise  the  line  would 
have  descended  at  some  point  as  in  the  ^'s"  of  Fig. 
99.  That  the  passage  was  not  wide  open,  however,  is 


180  STUTTERING   AND    LISPING 

shown  by  the  shght  elevation  of  the  Hne  during  the 
emission  of  the  breath  and  by  the  sudden  rise  (shght 
explosion)  in  the  line  at  the  end  of  the  ^^sh"  just 
before  the  vowel  begins.  The  sound  is  not  so  open 
as  in  the  normal  ^^sh."  The  impression  on  the  ear 
was  that  of  ^'tsoe"  rather  than  ''shoe." 

For  the  two  forms  of  ''th"  as  in  ''thick"  and 
"this,"  she  used  sounds  resembling  "t"  and  "d." 
For  "th"  the  tongue  is  pressed  against  the  palate 
at  the  sides,  but  the  contact  in  front  is  so  light  that 
the  air  escapes  (Fig.  71).  The  patient  pressed  the 
tongue  too  tightly  and  cut  off  the  air  entirely. 

The  condition  for  "k"  noted  in  Fig.  101  is  typical 
for  all  her  occlusives,  i.e.  sounds  involving  a  complete 
closure  of  the  mouth  passage;  namely,  "p,"  "b," 
"t,''  "d,"  "k,"  hard  "g."  In  these  she  regularly 
weakens  the  breath  pressure  before  they  end,  so  that 
they  have  no  explosions  when  the  tongue  or  the  lips 
release  the  tension.  This  is  quite  in  contrast  to  the 
incorrect  occlusives  that  she  makes  out  of  the  frica- 
tives "s"  and  "sh, "  etc.,  to  which  she  gives  strong 
explosions. 

The  case  seems  at  the  first  view  to  be  one  of  what 
has  been  termed ' '  negligent  hsping"  (p.  122) .  Children 


NEUROTIC    LISPING  181 

with  this  trouble  regularly  substitute  'H"  for  ^'s," 
'^d"  for  ^^z,"  and  "t"  and  ^'d"  for  the  two  forms 
of  ^Hh,"  just  as  this  person  does.  The  defect  arises 
from  the  same  cause,  namely,  pressing  the  tongue  too 
tightly  against  the  palate. 

The  excessive  tongue  action  in  negligent  lispers 
arises  from  negligent  observation  and  careless  action. 
The  children  with  negligent  speech  are  usually  those 
that  have  grown  up  in  surroundings  unfavorable  to 
careful  enunciation,  as  among  the  poorer  classes  or 
where  baby  talk  has  been  encouraged.  This  patient, 
however,  had  learned  to  talk  clearly.  Moreover,  she  is 
not  careless  about  her  speech,  but  overanxious.  Her 
tongue  touches  her  palate  not  simply  because  she  is 
too  negligent  to  take  the  pains  to  leave  a  small  open- 
ing, but  because  it  is  seized  by  an  uncontrollable 
spasm. 

It  is  evident  that  we  have  here  a  form  of  speech 
characterized  by  quick  nervous  muscular  action  in- 
stead of  the  deliberate  smooth  action  required  for  nor- 
mal sounds.  In  trying  to  make  the  ^^s,"  for  example, 
the  patient  is  too  nervous  to  carry  out  the  fine 
adjustment  requisite ;  she  presses  the  tongue  too 
tightly  and  thus  makes  a  'H."     The  result  for  the 


182  STUTTERING   AND    LISPING 

hearer  is  the  same  as  in  negligent  hsping,  but  the 
nervous  processes  in  the  two  diseases  are  quite  dif- 
ferent. 

Can  this  be  a  form  of  stuttering  where  the  exces- 
sive contractions  are  quite  limited  ?  A  never-failing 
symptom  in  stuttering  is  the  excessive  contraction 
of  the  laryngeal  muscles  whereby  the  laryngeal  tone 
becomes  hard  and  monotonous;  here  the  laryngeal 
tone  is  rather  soft  and  timid.  Moreover,  the  stut- 
tering cramps  are  never  confined  exclusively  and 
constantly  to  just  a  few  sounds.  They  frequently 
vary  from  time  to  time,  the  trouble  being  on  "p/' 
for  example,  during  one  month  and  on  ^^s"  during 
another  month.  Again,  the  stutterer  will  have 
trouble  not  on  a  single  consonant  wherever  it  occurs, 
but  on  consonants  in  a  certain  position,  generally 
initial  ones.  Facial  and  bodily  contortions  often  oc- 
cur with  stuttering,  but  I  have  never  found  tremor 
present.  We  must  conclude,  I  think,  that  this  is  not 
a  case  in  any  way  resembling  stuttering,  although 
the  cause  may  be  the  same. 

Another  case  was  that  of  a  girl  of  thirteen  who  lisped 
over  all  the  consonants.  Her  speech  was  at  times 
almost   unintelligible.     Treatment   along   the   lines 


NEUROTIC    LISPING  183 

of  muscular  and  mental  education  indicated  for 
negligent  lisping  produced  no  result.  She  was  an 
excessively  nervous  child,  and  she  spoke  with  in- 
credible rapidity.  As  she  was  gradually  quieted  down, 
the  hsping  decreased.  It  became  evident  that  the 
excessive  nervous  tension,  combined  with  self-con- 
sciousness, produced  a  tense  condition  of  the  vocal 
organs  allied  to  that  of  stuttering.  She  could  not 
produce  the  smooth  and  delicately  adjusted  move- 
ments of  normal  speech  because  her  muscles  were 
overtense. 

Another  case  of  nervous  lisping  was  that  of  a  girl 
of  twelve  whose  speech  was  mumbled.  Her 
mother  thought  her  tongue  w^as  too  long ;  her 
father  thought  there  was  something  the  matter 
with  her  intelligence.  The  methods  for  curing 
negligent  lisping  were  fruitless.  It  became  evident 
that  partial  deafness  had  made  it  hard  for  her 
to  learn  to  speak.  Being  a  sensitive  child,  the  con- 
stant correction  by  the  parents  and  the  embarrass- 
ment and  fear  before  them  had  produced  a  condition 
of  nervousness  much  as  in  the  previous  case. 
She  spoke  improperly  because  she  overinnervated 
the  speech  muscles.     She  began  to  improve  under 


184  STUTTERING   AND    LISPING 

quieting  treatment.  Unfortunately  the  parents  did 
not  trust  the  diagnosis,  and  preferred  to  regard  the 
defect  as  one  of  intellect. 

Neurotic  lisping  is  rather  frequently  found  combined 
with  stuttering.  A  patient  twenty-eight  years  old  was 
a  typical  stutterer.  At  the  same  time  his  speech  was, 
aside  from  his  stuttering,  so  indistinct  that  he  was 
frequently  asked  to  repeat  a  word.  For  example, 
he  would  say  that  he  had  been  to  Hartford  in  such  a 
way  as  to  leave  it  in  doubt  if  he  had  said  ^'Harwood," 
^'Harvard,"  ''Havre,"  or  something  similar.  The 
''s"s  and  ''n"s  were  weak  and  often  inaudible. 
The  explosions  of  the  occlusives  ''p,"  ''b,"  ''t,"  "d,'' 
^'k,"  ''g"  were  generally  omitted.  The  ''r"  sounded 
sometimes  like  ''u"  and  sometimes  like  ''1."  The 
words  were  often  contracted  to  unintelligible 
mumblings.  Treatment  by  the  methods  used  for 
negligent  lisping  made  the  trouble  worse.  The 
treatment  for  his  stuttering  included  methods  that 
caused  the  patient  to  relax  his  vocal  muscles.  It 
was  noticed  that  during  such  relaxation  the  con- 
sonants were  often  spoken  correctly.  It  was  thus 
evident  that  the  lisping  was  due  to  excessive  general 
innervation,  that  is,  that  it  was  neurotic  lisping. 


NEUROTIC   LISPIxVG  185 

For  different  iiil  (lia^iiosis  we  may  sum  up  as  fol- 
lows :  Neurol ie  lisping  is  allied  to  stuttering  in  its 
causation  (fright,  nervous  strain)  and  in  the  pres- 
ence of  an  emotional  disturbance.  It  differs  in  hav- 
ing excessive  muscular  tension  of  a  constant  rather 
than  a  spasmodic  kind ;  this  results  in  speech  some- 
what like  lisping  and  not  in  the  peculiar  sounds  of 
the  stutterer.  It  differs  from  negligent  lisping  in 
the  fact  that  it  appears  in  nervous  persons  and  not 
in  phlegmatic  or  dull  ones,  and  that  the  muscular 
movements  are  cramplike  instead  of  careless. 

The  general  treatment  is  mainly  that  for  neuras- 
thenia. General  hygiene,  mode  of  life  (school, 
profession),  moral  habits,  eyestrain,  nose  and  throat 
conditions,  etc.,  must  be  considered.  Arsenic, 
quinine,  strychnine,  and  other  tonics,  cold  rubs, 
lukewarm  or  cold  half  baths,  sprays,  moist  packs, 
electrotherapy,  massage,  change  of  climate,  and  sea 
baths  may  be  tried.  Open-air  exercise  is  always 
admirable.  Hypnotism  and  other  forms  of  psy- 
chotherapy are  often  most  efficient. 
.  The  special  speech  treatment  consists  in  ex- 
plaining the  trouble  to  the  patient  and  then  having 
him  repeat  sentences,   answer  questions,   and  talk 


186  STUTTERING   AND    LISPING 

in  a  relaxed  way.  The  relaxation  may  be  brought 
about  voluntarily  or  by  suggestion.  An  efficacious 
method  of  suggesting  relaxation  is  to  have  the  patient 
recline  on  a  couch  and  gradually  fall  into  a  semi-doze 
while  repeating  sentences  or  conversing. 


CHAPTER  V 

CLUTTERING 

Cluttering  is  characterized  by  great  nervousness 
that  shows  itself  in  excessive  rapidity  of  speech  with 
indistinct  enunciation.  When  the  patient  starts 
to  speak,  he  hastens  recklessly  through  what  he 
has  to  say.  The  nervous  hurry  of  his  mind  makes 
him  form  and  combine  the  sounds  imperfectly. 
Sounds,  syllables,  and  words  are  mumbled  together. 
The  breathing  may  become  spasmodic  and  irregular. 
A  normal  person  can  speak  as  rapidly  as  a  clutterer 
without  necessarily  losing  the  distinctness  in  enun- 
ciation ;  it  is  the  clutterer's  nervousness  that  produces 
the  defect. 

Cluttering  is  usually  combined  with  stuttering,  but 
it  can  be  distinguished  from  it.  In  the  one  there  is 
nervous  haste;  in  the  other  there  is  nervous  fear. 
The  clutterer  speaks  better  the  more  he  thinks  about 
his  speech,  the  stutterer  often  speaks  better  the  less  he 
thinks  about  it.     The  clutterer  shows  negUgence  and 

187 


188  STUTTERING    AND   LISPING 

lack  of  self-control ;  the  stutterer  cannot  release  him- 
self from  anxiously  watching  over  his  speech.  My 
experience  has  included  only  a  few  cases  of  clutter- 
ing without  stuttering.  Quite  a  few  stutterers  are 
also  clutterers. 

Cluttering  sometimes  produces  stuttering.  The 
cluttering  child  is  ridiculed  or  made  anxious  in 
other  ways  until  the  '-stutterer's  fear"  is  produced. 
One  unusually  bright  but  excessively  nervous  and  self- 
willed  boy  of  six  had  developed  a  language  of  his  owii, 
which  he  spoke  at  excessive  speed.  This  speech  was 
intelhgible  only  to  his  younger  brother,  who  had 
learned  to  speak  in  the  same  way.  His  notiong'df 
spelling  were  likewise  completely  confused.  The 
troublesome  situations  that  had  resulted  from  the 
cluttering  had  embarrassed  the  boy  and  made  hiiii 
anxiously  nervous,  with  the  result  that  he  both 
cluttered  and  stuttered.  ^^  -      , :  - 

Negligent  lisping,  when  it  includes  many  gotods, 
resenibles  cluttering  in  the  general  iiidistlnetiiess 
of  speech,  but  the  two  disorders  can  be  distinguished 
by  the  fact  that  in  cluttering  the  speech  is  quick  and 
hasty,  whereas  in  negligent  lisping  it  is  of  normal  or 
slow  speed.     With  very  slow  speech  the  cluttering 


CLUTTERING  189 

sometimes  disappears,  the  negligent  lisping  remains. 
All  sorts  of  sounds  are  affected  in  many  cases  of 
cluttering;  in  negligent  lisping  a  definite  set  is 
affected.  It  is  my  experience  that  some  clutterers 
make  a  set  of  defective  sounds,  such  as  ''s"  or 
''sh,"  incorrectly  even  when  they  speak  slowly.  It 
is  not  correct  to  say  such  cases  have  neghgent  lisp- 
ing also,  because  the  cause  —  namely,  the  mental 
attitude  —  is  utterly  different  in  the  two  cases. 

The  therapy  consists  of  tongue  gymnastics,  of 
exercises  in  enunciating  words  singly  and  in  com- 
bination, and  in  speaking  slowly  and  distinctly. 
If  the  clutterer  is  forced  to  enunciate  certain  sounds, 
such  as  the  explosives  (p.  117)  or  ''s"  very  distinctly, 
he  is  obliged  to  speak  slowly,  and  can  thus  learn  to 
enunciate  all  sounds  better.  The  breath  indicator 
(p.  119)  can  be  used.  In  severe  cases  the  treatment 
may  begin  with  singing.  The  nervousness  may  be 
combated  by  proper  hygiene,  tonics,  rest  cures, 
hypnotics,  or  psy chanalysis. 


PART   111 
EXERCISES 

SET  I 

BREATHING   (p.  84) 

1.   Active  Calisthenics 

A.  Standing,  breathing  while  raising  arms  fore 
upward  and  side  downward. 

B.  Same,  raising  arms  side  upward  and  down- 
ward. 

C.  Broad  standing  (that  is,  with  feet  separated), 
neck  firm  (that  is,  finger  tips  touching  back  of  neck, 
elbows  out),  sideward  bending  alternately  right  and 
left  (breathe  in  on  upward  movement). 

D.  Broad  standing,  neck  firm,  turn  trunk  to  right 
and  then  to  left  as  far  as  possible,  inspire  on  return- 
ing to  position. 

U,  Broad  standing,  hands  on  hips,  turn  to  right  as 

far  as  possible,  then  forward  and  backward,  inspire 

on  returning  to  position ;  continue  turning  to  left. 

190 


EXERCISES  191 

F.  Broad  standing,  arms  raised  upward,  bend 
forward,  rise  up. 

(In  all  these  exercises  inspiration  through  the  nose 
should  occur  as  the  ribs  are  expanded,  expiration 
through  the  nose  as  they  are  moved  inwards.  Each 
movement  is  to  be  performed  five  times  or  more.) 

2.  Regulation  of  Breathing 

A.  Standing,  place  one  hand  on  the  chest  and  the 
other  on  the  abdomen  ;  take  a  long  breath,  enlarging 
the  chest  in  all  directions,  and  drawing  the  abdomen 
in.  Expire  by  letting  the  chest  fall  and  the  abdomen 
spring  out.  Repeat  this,  always  trying  to  enlarge 
the  chest  still  more,  and  trying  to  blow  out  a 
stronger  breath  on  expiration. 

B.  Same  on  inspiration,  but  not  using  the  hands. 
On  expiration,  let  the  breath  pass  out  slowly.  Re- 
peat this,  trying  to  make  the  breath  last  longer  and 
longer. 

C.  Same,  except  that  a  powerful  ^^ah"  is  sung. 

D.  Same  inspiration,  sing  ^^ah"  as  long  as  possible, 
crescendo-diminuendo. 

(Breathing  is  to  be  done  with  open  mouth.  Each 
movement  is  to  be  performed  five  times  or  more.) 


192  STUTTERING   AND    LISPING 

3.  Breathing  and  Use  of  Twist  (p.  78) 

A.  Raise  the  arms  side  upward,  inhaling,  lower 
side  downward,  singing  ^^ah"  on  middle  c. 

B.  Raise  the  arms  side  upward,  inhaling ;  lower 
side  downward,  singing  '^ah"  sliding  from  middle  c 
to  high  c  (octave  twist). 

C  Likewise,  speaking  words  of  one  syllable  with 
the  octave  twist. 

D.  Likewise  speaking  words  of  two  syllables  with 
the  octave  twist  on  the  first  vowel. 

(Each  step  is  to  be  done  a  number  of  times.) 

4.  Regulation  of  Breath  in  Singing 

A.  Sing  a  short  song  with  inspiration  before  each 
line. 

B.  Sing  two  lines  with  one  breath. 

C.  Sing  three  lines  with  one  breath. 

D.  Sing  four  lines  with  one  breath. 

5.  Regulation  of  Breath  in  Reading 

Take  a  full  breath  before  each  sentence  or  phrase ; 
wait  one  second,  not  letting  any  breath  out.  Then 
speak  the  sentence  or  phrase  slowly  in  one  breath; 
do  not  breathe  in  the  middle.  Use  a  text  with  short 
sentences,  poems,  and  longer  prose  pieces. 


EXERCISES  193 

6.  Regulation  of  Breath  in  Speaking 

Holding  a  stick  in  the  hand,  raise  it  each  time  before 
speaking,  while  breath  is  inspired  vigorously.  After 
waiting  one  second  with  bated  breath,  speak  as  in- 
tructed. 

A.  Read  a  short  sentence  after  the  instructor. 

B.  Answer  the  question  of  the  instructor. 

C.  Make  a  sentence  concerning  some  topic  assigned 
by  the  instructor. 

D.  Give  a  description  of  some  object  pointed  out 
by  the  instructor,  breathing  vigorously  before  each 
sentence. 

(The  first  two  parts  of  this  exercise  can  be  con- 
veniently combined  into  the  ^'  statement  and  question 
exercise."  The  instructor  gives  a  series  of  state- 
ments and  questions.  Each  statement  is  to  be 
repeated,  and  each  question  is  to  be  answered.  The 
confidence  gained  by  the  pupil  in  repeating  the 
statement  helps  him  in  answering  the  questions.  A 
book  on  ^Hravel  talk"  supplies  convenient  material. 
See  also  p.  92.) 


194  STUTTERING   AND    LISPING 

SET  II 

MELODY    (p.  74) 

7.  Giving  the  Idea  of  Melody 

A.  Sing  a  short  song  in  the  key  appropriate  for  the 
pupil's  voice  with  inspiration  before  each  hne. 

B.  Speak  the  words  of  this  song  on  the  same  notes, 
the  piano  being  played  at  the  same  time. 

C.  Same  as  B  without  the  piano. 

D.  Speak  the  words  melodiously,  that  is,  with  a 
rise  and  a  fall  of  the  voice,  but  not  necessarily  on 
the  same  notes  as  the  song. 

E.  Speak  the  words  of  the  song  melodiously,  but 
with  perfect  freedom. 

8.  Introducing  Melody  into  Speech  (p.  91) 

A.  Sing  a  short  song,  speaking  the  last  word  of  each 
line  instead  of  singing  it. 

B.  Repeat,  speaking  the  last  two  words. 

C.  Repeat,  speaking  the  last  three  words. 

D.  Continue  in  the  same  way,  adding  word  by 
word  until  the  whole  song  can  be  spoken  perfectly. 

E.  Sing  some  statement,  for  example,  ^' New  York 
is  a  very  large  city.''     Repeat  it,  speaking  the  last 


EXERCISES  195 

word.     Then  repeat  it,  speaking  the  last  two  words. 
Continue  as  before. 

F.  Question  and  answer.  The  instructor  gives  the 
question,  the  patient  gives  the  answer.  First  sing 
them,  then  speak  the  last  word,  then  last  two  words, 
etc. 

9.  Introducing  Melody  into  Recitation 

A.  Recite: 

^^Oh,  look  at  the  moon!     She  is  shining  up  there. 
Oh,  mother,  she  looks  Hke  a  lamp  in  the  air. 
Last  week  she  was  smaller,  just  like  a  bow ; 
This  week  she  is  larger  and  round  as  an  0." 

The  voice  is  to  rise  and  fall  somewhat  in  the  follow- 
ing way : 

moon  shining 

look 

the  is  there. 

Oh,  at  she  up 

B.  Recite  other  pieces  of  verse  and  prose  likewise. 

10.  Introducing  Melody  into  Conversation 
A,   A  question  is  sung  on  some  simple  melody  or  on 
the  notes  c,  e,  g,  c  \  or  as  a  chant  on  one  or  two  notes. 
The  answer  is  sung  likewise.     It  is  of  no  account 


196  STUTTERING  AND   LISPING 

whether  the  syllables  exactly  fit  the  notes  or  not. 
This  is  repeated  until  there  is  no  difficulty;  each 
of  the  following  steps  is  also  to  be  repeated  until  at 
least  fair  success  is  obtained. 

B.  Statements  are  alternated  between  two  per- 
sons in  the  same  musical  way.  At  first  the  state- 
ments may  be  disconnected;  ^^Rice  grows  in 
the  Southern  states";  '^New  York  is  the  largest 
city  in  America."  Gradually  they  are  to  be  turned 
into  a  connected  conversation. 

C.  Same  as  A,  but  speak  the  words  with  piano 
accompaniment . 

D.  Same  as  Bj  but  with  words  spoken  to  accom- 
paniment. 

E.  Question  and  answer  without  the  piano,  but 
with  attempt  at  the  melody  used  before. 

F.  Statements  hkewise. 

G.  Question  and  answer  melodiously,  but  freely. 
H.  Statements  likewise. 

11.   Training  the  Ear  to  Control  the  Voice 
A.   Sing  ^^ma"  on  each  of  the  notes  as  indicated. 


l,J_J_j_iZp^^EE^Ej=^ 


EXERCISES 


197 


B.    Sing  ''ma"  on  each  of  the  notes  of  the  scale 
going  upward  and  downward. 


m=^ 


— i — ^- 


-^ — • 


^E^ 


±=^ 


•—^ 


4-^--^ 


1 


C.  Sing  ''ma"  on  each  of  the  notes  of  the  scale, 
beginning  and  ending  it  very  faintly,  and  making 
it  long. 


i 


~z>- 


-<9 i2_ 


^  -^Z.      ^-^      <>      <>      <>      <>      <>      <> 

D.    Sing   "ma"   upward  and  downward  on  the 
notes  c,  e,  g,  c\ 

i 


3E3: 


d: 


SET  III 

FLEXIBILITY  (p.  74) 

12.  Singing 

A.  Sing  the  vowel  "ah,  '  hrough  the  notes  of 
the  octave. 

R.  Strike  the  lowest  note  of  the  octave,  then  the 
highest;  sing  the  vowel  "ah,"  half  on  the  lowest 
note,  half  on  the  highest. 

C.  Sing  the  vowel  continuously  (portamento) 
over  the  octave  (octave  twist). 


198  STUTTERING   AND    LISPING 

D.  Practice  singing  the  different  vowels  over  the 
octave  in  this  way. 

E.  Sing  a  series  of  one-syllable  words  with  long 
vowels,  running  the  vowels  up  in  the  same  way. 

13.   Speaking 

A.  The  instructor  speaks  a  word  with  the  octave 
twist.     The  pupil  repeats  it. 

B.  Same  with  sentences,  putting  the  octave  twist 
on  the  first  important  vowel  (the  first  important 
vowel  is  not  necessarily  the  first  vowel). 

C  Same  with  poems,  putting  the  octave  twist 
on  the  first  important  vowel  in  each  line. 

D.  Same  with  prose,  putting  the  octave  twist  on 
the  first  important  vowel  in  each  phrase. 

E.  Statement  and  question  exercise  (see  note  to 
Exercise  6)  with  the  octave  twist. 

SET  IV 

SLOWNESS    (p.  85) 

(It  is  advisable  to  give  the  ^'octave  twist"  to  the 
first  important  vowel  in  each  sentence,  as  under 
Flexibility,  Exercise  13,  B.) 


EXERCISES  199 

14.   Speaking  with  Lengthened  Vowels 

A.  Repeat,  after  the  instructor,  single  monosyl- 
lables, making  the  vowel  three  times  as  long  as  nor- 
mally. 

B.  Repeat  words  of  more  than  one  syllable^ 
lengthening  the  chief  vowel  likewise. 

C.  Repeat  short  sentences  likewise. 

D.  Read  words  from  a  book  likewise. 

E.  Read  poems  likewise. 

F.  Read  prose  likewise. 

G.  Answer  questions  likewise. 
H.  Tell  a  short  story  likewise. 

15.    Speaking  Together  (pp.  62,  94) 

A .  Repeat  or  read  a  poem  in  unison  with  another 
person  speaking  slowly. 

B.  Repeat  or  read  it  alone  slowly. 

C.  Repeat  or  read  a  prose  piece  with  another 
person  slowly. 

D.  Repeat  or  read  it  alone  slowly. 

E.  Alternate  C  and  D,  a  few  sentences  of  each. 

F.  Read  conversation  (dramas,  traveler's  manual, 
etc.)  slowly  with  another  person. 

G.  Free  conversation,  question  and  answer. 


200  STUTTERING   AND    LISPING 

16.   Metronome  Exercise  (p.  85) 

A.  Speak  sentences  to  a  metronome  beating  54 
to  a  minute,  with  one  syllable  to  each  beat. 

B.  Statement  and  question  exercise  likewise 
(see  note  to  Exercise  6). 

C.  Tell  a  connected  story  likewise,  such  as  what 
you  had  for  breakfast,  how  you  spent  last  summer,  etc. 

D.  Repeat  A,  B,  C  while  some  one  holds  the  finger 
on  the  metronome  ready  to  act  whenever  you  speak 
too  fast. 

E.  Repeat  A,  B,  C,  D  without  the  metronome. 

F.  Repeat  A,  B,  C,  D  without  the  metronome, 
taking  care  to  eliminate  all  jerkiness  of  speech. 

17.   Speaking  ivith  Sticks 

A.  Repeat  sentences,  striking  the  stick  to  each  em- 
phatic vowel  and  keeping  time  with  the  metronome 
at  54  a  minute. 

B.  Same  without  the  metronome. 

C.  Question  and  answer  likewise  (see  note  to 
Exercise  6). 

D.  Same  without  the  metronome. 

E.  Tell  a  story  about  breakfast,  etc.,  keeping  time 
to  the  metronome. 


EXERCISES  201 

SET  V 

SMOOTHNESS 

18.   Linking 

A.  Repeat  and  read  sentences,  linking  all  the  words 
together,  that  is,  making  no  pause  or  interruption 
between  the  different  words.  The  whole  sentence 
should  be  spoken  as  if  it  were  one  word,  or  just  as  in 
French.  '^Thecoverofthebookisred."  '' Thecarpet- 
onthefloorisgreen . "  ' '  Theelectriclightisvery  conven- 
ient."    ''  TheturkeycomesonThanksgivingDay." 

B.  Repeat  and  read  short  stories  likewise. 

C.  Repeat  sentences  and  answer  questions  likewise. 

19.  Vowel  Start 

A.  Read  sentences,  making  the  first  important 
vowel  in  each  sentence  at  least  three  times  as  long 
as  usual.  Speak  it  with  the  octave  twist.  Speak 
the  rest  of  the  sentence  as  described  in  the  exercise 
on  "Linking.'^ 

B.  Read  likewise. 

C.  Repeat  sentences  and  answer  questions  like- 
wise. 

Z).  Conversation  likewise. 


202  STUTTERING   AND    LISPING 

SET  VI 

VOICE   QUALITY    (p.  81) 

20.    Tone  Placing  by  Chanting 

A.  Chant  one  line  of  a  poem  or  a  prose  statement 
on  one  note. 

B.  Repeat  this  on  other  notes. 

C.  Same,  dropping  to  a  lower  note  on  the  last  word. 

D.  Same,  short  story. 

E.  Same,  statements,  question  and  answer. 

21.   Tone  Placing  with  ' '  Bee-hee-hee ' ' 

A.  Strike  middle  c  and  sing  ^ ^ bee-bee-bee, "  mak- 
ing the  vowel  sharp  as  in  the  French  word  ^^ pique"  ; 
this  is  far  more  sharp  than  the  English  word  ^'peek." 
Go  up  the  scale  for  an  octave  in  the  same  way. 

B.  Same  with  ^^bee-ah." 

C.  Same  with  '' bee-ay." 

D.  Same  with  ^^bee-oh." 

E.  Same  with '^bee-you." 

F.  Same  with  ^^bah." 

G.  Same  with  ''bay." 
H.  Same  with  ''boh." 
7.    Same  with  "bou." 


EXERCISES 


203 


All  these  vowels  should  be  sung  in  a  ringing,  very 
slightly  nasal  tone,  that  is,  in  what  is  termed  a  "  for- 
ward tone." 

22.   Tone  Placing  with  '^Ma^^ 

A .  Strike  middle  c  and  sing  ' '  mmmmmmaaaaaah." 
Hold  '^m"  until  the  vibrations  are  felt  strongly  on 
the  lips ;  then  simply  open  the  mouth  to  let  the 
'^ah''  out,  being  careful  to  keep  the  same  quaUty 
of  tone  as  in  "m."  For  a  high  voice  begin  above 
middle  c. 

B.  Repeat  up  the  scale  for  an  octave. 


^=r^- 


atm* 


C,  Same  with  "mee"  ;   same  with  ^^moh"  ;    same 
with  "moo." 

D.  Repeat  on  arpeggios  of  three  and  four  notes. 


tHji^ij^rmmm 


Ma  ma  ma  ma  ma 


*f 


:i=J=* 


4=4=* 


m 


etc. 


^±:rjlr=±3t±z^ 


-•  1  # 


i 


fe 


w^=^* — '-'^-^^ 


Ma  ma  ma  ma  ma  ma  ma 


etc. 


204  STUTTERING   AND    LISPING 

23.  Husky  Tone 

A.  Strike  middle  c  and  sing  ''ah/'  beginning  and 
ending  it  with  the  glottal  catch  (p.  81).  Continue 
up  the  scale. 

B.  Sing  arpeggios  likewise. 

C.  Sing  ''ah"  to  the  notes  of  a  song  likewise. 

D.  Sing  a  song,  cutting  all  the  words  sharply 
apart. 

24.    Trumpet  and  Megaphone 

A.  Hold  a  small  trumpet  to  your  lips.  Shout 
through  it  the  phrase  ^ '  Pie-apples,  ten  cents  a  water 
pail/'  using  the  sharp  tones  that  would  be  used  by 
a  peddler  calling  out  on  the  street.  Use  other  phrases 
in  the  same  way,  for  example,  "Nice  fresh  straw- 
berries." ,  ' 

B.  Call  out  railway  stations  in  a  similar  way. 

C.  Same  with  a  small  megaphone.  Note  that  you 
have  to  make  somewhat  more  of  an  effort  to  get  the 
sharpness  with  the  megaphone. 

Z).  Repeat  all  the  preceding  without  anything 
before  the  mouth.  Make  a  special  effort  to  get  the 
sharp  ringing  tone. 


EXERCISES  205 

SET   VII 

STARTING   AND    ENDING    SENTENCES 

25.    Strengthening  the  First  Word 

A.  Sing  short  sentences,  striking  a  note  on  the 
piano  as  you  sing  the  first  syllable.  Instead  of 
using  the  piano  you  may  strike  a  bell  or  a  table  or 
you  may  hit  your  knee  or  make  a  gesture  as  in  beat- 
ing time. 

B.  Repeat  the  same  sentences,  with  the  same 
accompaniment  in  the  same  way,  but  singing  only 
the  first  word. 

C.  Speak  them  with  the  same  accompaniment 
on  the  first  syllable. 

D.  Question  and  answer  are  sung  with  the  ac- 
companiment on  the  first  syllable. 

E.  As  before,  but  only  the  first  syllable  sung, 
the  rest  being  spoken. 

F.  As  before,  but  all  spoken. 

G.  Tell  a  story,  singing  the  first  word  of  each 
sentence  with  the  accompaniment. 

H.  Tell  a  story  without  singing,  but  accompany- 
ing each  first  syllable. 


206  STUTTERING    AND   LISPING 

26.   Emphasizing  Periods 

A .  Read  short  sentences,  striking  a  bell  or  a  piano 
note  at  the  period. 

B.  Read  a  story  Ukewise. 

C.  Question  and  answer  likewise. 

D.  Tell  a  story  likewise. 

E.  Raise  a  heavy  weight  in  the  hand  and  hold  it 
till  a  period  is  reached.  Read  and  speak  sentences, 
stories,  etc. 

27.  Lowering  Tones  at  the  End 

A.  Chant  sentences  on  one  note,  but  drop  by  a 
fifth  —  sol  to  do  —  on  the  last  syllable.  Use  the 
piano  at  first,  but  gradually  omit  it. 

B.  Speak  sentences  on  a  rather  high  tone,  and 
drop  on  the  last  word. 

28.   Clear  Endings 

A.  Sing  sentences,  cutting  the  last  word  short 
with  the  glottal  catch. 

B.  Speak  sentences,  singing  the  last  word  sharply. 

C.  Speak  sentences,  making  sure  that  the  last 
syllable  is  sharp. 


EXERCISES  207 

SET  VIII 

ENUNCIATION    AND    SPELLING   (p.  88) 

29.    Typical  Sounds  (p.  117) 

A.  Indicate  by  printed  or  written  letters  on 
paper,  blackboard,  or  chart  the  typical  explosives 
'^p,  b,  d,  t,  k,  g";  show  their  explosions  by  paper 
flags  or  the  breath  indicator  (pp.  153,  119). 

B.  Indicate  the  typical  fricatives  '^f,  v,  s,  z,  sh, 
th.'' 

C.  Indicate  the  occlusive-fricatives  *'ch  and   j." 

D.  Indicate  the  nasals  ''m,  n,  ng, "  showing  that 
air  issues  through  the  nose. 

E.  Indicate  the  liquids  '4,  r. " 

F.  Indicate  the  semi- vowels  ''w,  y.'' 

30.    Combination  of  Sounds  into  Syllables 

A.  Combine  each  of  the  explosives  " p,  b,  t,  d,  k,  g  " 
with  various  vowels ;  indicate  the  result  on  paper, 
blackboard,  or  chart  and  speak  it  at  the  same  time ; 
thus,  ''pa,  pay,  pee,  po,  pu,  ba,  bay,  bee,  bo,  boo,"  etc. 

B.  Same  with  fricatives  and  the  other  sounds  of 
the  previous  exercise;  thus  ''fa,  fay,  fee,  fo,  foo, 
va,  vay,  vee,  vo,  voo,"  etc. 


208 


STUTTERING  AND   LISPING 


C.  Form  syllables  with  explosives  followed  by 
'^r'^  and  the  vowels:  thus,  ^'pray,  pree,  pro,  proo, 
bray,  bree,  bro,  broo,"  etc. 

D.  Same  with  "V  instead  of  ^'r";  thus,  ^'play, 
plee,  plo,  ploo,  blay,  blee,  bio,  bloo,"  etc. 

31.   Division  of  Words  into  Syllables  (p.  88) 

A.  Learn  to  spell  words,  dividing  them  into  syl- 
lables according  to  the  dictionary.  Pronounce  each 
syllable  separately,  for  example,  "a-c,  ac,  c-e-1, 
eel,  e-r,  er,  a-t-e,  ate,  accelerate." 


SET  IX 

EXPRESSION 

32.   Giving  the  Idea  of  Emphasis 

A.    Sing    ^^ah"    with    notes    on    the    piano    as 
indicated. 


i 


w- 


d; 


^- 


This  gives  an  idea  of  emphasis  by  change  in  pitch. 
B.    Sing  "ah"   on  one  note  but  with  different 
lengths  as  indicated. 


i 


-<$f- 


d: 


-•-    -•- 


EXERCISES  209 

This  gives  the  idea  of  emphasis  by  change  of 
length. 

C.  Sing  ^ah"  on  the  same  note  and  with  the  same 
length,  making  the  first  one  of  each  group  of  three 
louder  than  the  others. 


i 


J-   -J-   -J-     -#-  -€h 


=1: 


This  gives  the  idea  of  emphasis  by  change  in  loud- 
ness. 

33.   Developing  Expression 

In  each  of  the  following  exercises  the  instructor 
first  shows  the  pupil  just  what  he  is  to  do.  He 
criticizes  the  pupils  deficiency,  and  imitates  him 
where  he  fails  to  get  the  proper  expression. 

A,  Repeat  a  poem  with  expression. 

B,  State  a  certain  fact  in  a  very  melodious  and 
expressive  way. 

C,  When  the  instructor  gives  a  question  in  a  very 
melodious  and  expressive  voice,  answer  it  by  taking 
a  few  words  from  the  question. 

D,  As  before,  but  answer  freely  with  the  same 
melody  and  expression  as  in  the  question. 

E,  Recite  poems  and  prose  pieces  with  proper 
expression. 


210  STUTTERING   AND    LISPING 

F,  Read  dialogues  with  the  proper  change  of  ex- 
pression for  each  character. 

G,  Read  and  speak  jokes  with  an  effort  to  give  the 
most  effective  expression. 


SET  X 

CONFIDENCE   (p.  90) 

34.   Reading  Together  (pp.  62,  94) 

A.  Read  a  poem  together  with  the  instructor. 
Read  alternate  Hnes  together  and  alone. 

B,  Same  with  sentences. 

C  Read  a  prose  speech  together ;  the  instructor 
is  to  remain  silent  occasionally. 

D.  Read  a  prose  piece;  the  instructor  is  to  join 
in  at  the  first  intimation  of  difficulty. 

E.  Read  statements  and  questions  sometimes  to- 
gether, sometimes  alone  (see  note  to  Exercise  6). 

F.  Read  parts  in  a  drama;  the  instructor  joins  in 
whenever  the  pupil  has  difficulty. 

G.  Read  a  paragraph,  and  then  tell  its  contents  in 
your  own  language;  the  instructor  joins  in  wherever 
there  is  any  difficulty. 


EXERCISES  211 

35.   Speaking  Together  (p.  62) 

A.  Repeat  a  poem  in  unison  with  another  person, 
speaking  slowly. 

B.  Repeat  it  alone  slowly. 

C.  Repeat  a  prose  piece  with  another  person  slowly. 

D.  Repeat  it  alone  slowly. 

36.   Reading  with  Decided  Voice  (p.  98) 

A.  Call  off  the  railroad  stations  from  a  time-table 
through  the  megaphone.  The  voice  must  ring  out 
clearly  and  decidedly. 

B.  Same  without  the  megaphone. 

C.  Read  headlines  from  a  newspaper  in  a  similar 
way. 

D.  Read  short  sentences  likewise. 

E.  Read  short  poems  likewise. 

F.  Read  short  prose  pieces  likewise. 

G.  Read  jokes  likewise. 

Speaking  with  Confidence  (pp.  94,  95) 

A.  Call  out  railroad  stations  with  the  megaphone; 
the  voice  must  be  clear  and  decided. 

B.  Same  without  the  megaphone. 

C   Make  geographical  statements  with  and  without 


212  STUTTERING   AND   LISPING 

the  megaphone;   for  example,  ^^The  Atlantic  Ocean 
is  east  of  the  United  States." 

D.  Make  historical  statements  likewise  (that  is, 
with  and  without  the  megaphone) ;  for  example, 
^'George  Washington  was  the  first  president  of  the 
United  States/' 

E.  Question  and  answer  likewise. 

F.  Relate  a  story  of  an  incident  likewise. 

G.  Make  a  speech  likewise. 

H.  Take  part  in  a  debate  likewise. 

7.  Take  part  in  a  continuous  story  which  is  ar- 
ranged as  follows :  One  person  tells  a  story  which 
he  makes  up  as  he  goes  along;  he  suddenly  stops, 
and  the  next  person  is  immediately  to  continue  the 
story  according  to  his  own  ideas ;  he,  in  turn,  sud- 
denly stops  and  the  following  person  continues. 
This  is  kept  up  until  the  story  reaches  the  first  person. 

38.   Buying  (p.  96) 

A.  You  are  supposed  to  be  a  storekeeper  with  a 
number  of  objects  before  you ;  other  people  go  to  the 
store,  inquire  about  articles,  discuss  the  prices  and 
buy.  This  must  all  be  done  with  proper  attention 
to  slowness  and  melody  of  speech. 


EXERCISES  213 

B.  Take  the  part  of  the  buyer. 

C.  The  store  is  turned  into  a  railroad  ticket  office 
with  yourself  alternately  as  ticket  agent  and  as  trav- 
eler. Various  questions  concerning  trains,  accommo- 
dations, etc.,  are  to  be  asked. 

D.  The  ticket  office  becomes  the  box  office  at  the 
theater ;  the  questions  are  to  include  location  and 
seats,  exchange  of  tickets,  etc. 

39.   Introducing  (p.  63) 

A.  The  instructor  introduces  himself  to  you; 
you  reply,  ''I  am  glad  to  meet  you.'' 

B.  Introduce  yourself  to  the  instructor. 

C.  The  instructor  introduces  some  other  person 
to  you,  you  reply  ^^  am  glad  to  meet  you"  or 
''How  do  you  do?" 

D.  The  instructor  introduces  you  to  another  per- 
son ;  you  say  ''How  do  you  do  ?  " 

E.  Introduce  yourself  to  another  person. 

F.  Introduce  the  instructor  to  different  persons. 

G.  Introduce  different  persons  to  the  instructor. 
H.  Introduce  two  familiar  persons  to  each  other. 
/.     Introduce  strangers  to  each  other. 

As  much  as  possible  the  stutterer  should  feel  that 


214  STUTTERING   AND    LISPING 

the  instructor  is  at  hand  to  speak  for  him  in  case  of 
any  difficulty. 

40.  Public  Speaking  (p.  95) 

A.  Prepare  a  short  speech  to  make  on  an  assigned 
topic,  and  deliver  it  in  the  presence  of  the  instructor. 

B.  Same  in  the  presence  of  several  people. 

C.  Make  an  impromptu  speech  on  a  given  topic  in 
the  presence  of  the  instructor. 

D.  Same  in  the  presence  of  other  people. 

The  number  of  the  people  is  to  be  gradually  in- 
creased until  the  stutterer  feels  ready  to  get  up  at  any 
moment  and  make  a  short  speech  on  any  topic. 

41.  Scenes  from  Life  {p.  95) 

A.  A  group  of  people  is  supposed  to  be  in  some 
familiar  situation ;  for  example,  eating  at  a  restau- 
rant, riding  in  an  automobile,  forming  a  box  party  at 
the  theater,  etc.  The  instructor  works  out  the  situa- 
tion by  description,  while  the  persons,  including  the 
pupil,  make  the  appropriate  remarks.  For  example, 
if  the  scene  is  at  the  restaurant,  the  instructor  takes 
the  part  of  the  waiter,  while  the  other  persons  order 
what  they  wish  to  eat,  discuss  the  bill  of  fare,  etc. 
If  the  scene  is  at  the  theater,  the  instructor  tells  a 


EXERCISES  215 

story  of  the  play  while  the  persons  discuss  the  inci- 
dent, the  house,  their  neighbors  etc.  In  the  auto- 
mobile party,  the  instructor  takes  the  part  of  the 
chauffeur  while  the  party  travels  to  various  places 
and  discusses  what  he  has  seen. 

B.  Similar  scenes  are  worked  out,  the  patient  tak- 
ing the  leading  part. 

C.  The  group  of  persons  is  supposed  to  represent 
a  club,  the  instructor  occupying  the  chair.  Varioiis 
members  are  to  make  motions  and  discuss  them, 
officers  are  to  be  elected,  etc. 

D.  The  stutterer  is  made  chairman  of  the  club. 

42.  School  Work  (p.  96) 

A.  The  stutterer  is  to  prepare  and  recite  to  the 
instructor  some  of  his  school  exercises. 

B.  He  is  to  do  the  same  before  several  people. 

C.  The  group  is  to  be  gradually  increased  till  it 
forms  quite  a  class.  The  instructor  is  to  be  the 
teacher  and  is  to  call  on  the  patient  or  patients  to 
recite. 

D.  The  exercise  is  transferred  to  a  schoolroom. 

E.  Outside  teachers  are  called  in  to  conduct  the 
class. 


216  STUTTERING  AND   LISPING 

SET  XI 

SPONTANEOUS   SPEECH 

43.  Collection  of  Ideas  (pp.  14,  19,  62) 

A.  Say  some  word  referring  to  an  object  placed 
before  you  or  pointed  out ;  the  word  must  have  some 
apphcation  to  or  connection  with  the  object.  You 
may  say  ^^ large"  referring  to  its  size,  or  ^' black" 
referring  to  its  color,  or  ^^read"  referring  to  its  use, 
or  ^Hable"  referring  to  its  position,  or  '^yesterday" 
referring  to  something  it  reminded  you  of,  etc. 

B.  Make  a  statement  slowly  and  melodiously  con- 
cerning some  object  placed  before  you  or  pointed  out 
to  you. 

C.  Name  the  objects  you  see  on  one  side  of  the 
room,  proceeding  systematically  from  left  to  right 
and  speaking  slowly  and  melodiously. 

D.  Describe  an  object  placed  in  front  of  you,  us- 
ing single  words  and  proceeding  systematically ;  for 
example,  if  a  telephone  is  placed  before  you,  you 
will  first  use  words  referring  to  its  appearance,  then 
to  its  use,  then  to  its  faults,  then  to  its  history,  etc. 
Always  adopt  some  such  system  in  selecting  words. 


EXERCISES  217 

E.  Same  as  /),  hut  complete  sentences  are  to  be 
used  instead  of  single  words. 

F.  Short  sentences  are  to  be  spoken  concerning 
objects  not  seen  but  more  or  less  familiar;  for 
example,  breakfast,  a  distant  city,  George  Washing- 
ton, Atlantic  Ocean,  etc. 

G.  A  more  extended  account  is  required  concerning 
similar  objects,  as  in  F. 

44.  Increasing  the  Embarrassment  (p.  62) 

A.  Part  or  all  of  the  preceding  exercise  is  to  be 
carried  out  in  the  presence  of  additional  people. 

B.  When  this  can  be  done  perfectly,  you  are  to  be 
called  on  to  make  short  speeches  on  topics  that  have 
been  given  you  before. 

C.  You  are  to  make  speeches  on  topics  of  your  own 
choosing. 

SET  XII 

THINKING    (p.  86) 

45.  Singh  Associations  of  Ideas 
A.  The  name  of  an  object  is  called  out.    You  call 
out  the  name  of  some  other  object  that  suggests 
itself  to  your  mind.     If  you  are  in  doubt  what  to  say, 


218 


STUTTERING  AND   LISPING 


choose  some  object  that  is  often  seen  together  with 
the  one  mentioned.  For  example,  on  hearing  the  word 
^^ horse"  you  reply  ^^cart."  This  process  is  called 
'^association  of  ideas."  For  the  present  you  are  to 
associate  slowly,  taking  as  much  time  as  you  wish. 
Practice  for  several  times  with  the  following  list 
of  words ;  then  add  other  words. 


hand 

foot 

hair 

shoe 

glove 

eye 

coat 

sock 

motor 

tooth 

nose 

water 

boat 

canoe 

whip 

sail 

pin 

wheel 

rope 

seat 

road 

pump 

lake 

ticket 

lamp 

bell 

dance 

theater 

hotel 

ring 

piano 

gun 

bell 

street 

head 

muscle 

school 

collar 

pencil 

B.  Upon  hearing  each  of  the  words  just  used,  make 
a  sentence  about  it.  It  does  not  matter  what  the 
sentence  states. 


EXERCISES  219 

C.  Upon  hearing  each  of  the  words  make  a  sen- 
tence defining  it. 

D.  Upon  hearing  each  of  the  words  state  some  fact 
about  the  object  implying  something  in  regard  to  its 
location  or  its  use,  or  something  that  preceded  it, 
or  caused  it,  or  followed  it,  or  resulted  from  it,  or 
had  some  relation  to  it. 

46.  Running  Associations 

Starting  with  any  given  word,  let  the  mind  bring 
up  a  long  series  of  thoughts.  These  thoughts 
should  not  revolve  around  the  original  word,  but 
should  pass  away  into  other  subjects.  If  necessary, 
the  rule  may  be  adopted  of  obhging  the  mind  to  leave 
the  original  word  within  three  associations. 

SET  XIII 

DESCRIPTION    AND    RELATION 

47.  Description  (p.  19) 

A.  Describe  an  object  placed  before  you;  if  you 
have  any  difficulty,  you  are  to  adopt  some  system, 
such  as  proceeding  from  top  to  bottom  or  according 
to  cause  and  effect,  etc. 

B.  Same  with  simple  pictures. 


220  STUTTERING  AND   LISPING 

C.  Same  with  complicated  pictures. 

D.  Same  with  what  you  see  in  the  room  or  out  of 
the  window. 

E.  Same  with  a  simple  topic  from  memory,  such  as 
breakfast  this  morning,  house  where  you  live,  school, 
well-known  buildings,  etc. 

F.  Same  with  a  longer  experience,  such  as  a  journey, 
a  visit  to  a  theater,  the  plot  of  a  story,  etc. 

G.  All  the  preceding  exercises  are  to  be  performed 
in  the  presence  of  one  other  person,  then  two,  and  so 
on. 

48.  Relation 

A.  Read  aloud  a  short  story,  for  example,  one  of 
iEsop's  fables ;  then  with  the  book  open  before  you 
relate  the  contents  of  the  story. 

B.  Same  with  the  book  closed. 

C.  Relate  some  story  that  you  have  previously 
read,  for  example,  Robinson  Crusoe,  Cinderella,  etc. 

D.  Same  with  some  previous  experiences,  such  as 
last  summer,  last  Christmas,  etc. 

E.  Read  a  joke  and  then  tell  it. 

F.  Tell  some  funny  story  that  you  read  some  time 
ago. 


EXERCISES  221 

G.  Tell  what  you  would  like  to  do  next  summer, 
next  Christmas,  etc. 

H.  All  these  exercises  are  to  be  done  in  the  presence 
of  one  additional  person,  then  two  persons,  etc. 

/.  Pretend  that  you  are  conducting  a  scene  in 
vaudeville. 

SET  XIV 

TELEPHONING    (p.    96) 

49.  Private  Line 

A.  Call  up  some  one  on  the  private  telephone, 
using  the  system  of  your  town  as  nearly  as  possible. 
First  ca^ll  ^'  central,'^  and  then  speak  with  the  person 
desired.     You  are  to  speak  slowly  and  melodiously. 

B.  Take  the  part  of  ^'central"  and  then  of  the 
person  called  up. 

C.  Repeat  A  and  B  in  the  presence  of  other  people. 

D.  Do  some  of  the  most  difficult  exercises  over 
the  telephone  with  the  instructor  or  some  other 
person  at  the  other  end. 

50.  Main  Line 

A.  Put  your  finger  on  the  telephone  switch  so 
that  when  you  take  the  receiver  off  the  hook,  the 


222  STUTTERING  AND   LISPING 

telephone  is  not  connected  with  ' '  central. ' '  Some  one 
sitting  beside  you  takes  the  part  of ''  central "  and  the 
person  to  whom  you  wish  to  speak.  Carry  out  exer- 
cises as  on  the  private  Hne. 

B.  With  the  instructor  close  beside  you,  call  up 
''central"  and  then  some  friends;  if  you  have  the 
shghtest  hesitation,  the  instructor  will  speak  for 
you. 

C.  When  you  succeed  perfectly  as  in  B,  try  the 
telephone  independently.  The  instructor  is  to  criti- 
cize your  success. 

SET  XV 

TALKING   WITH    PEOPLE    (p.  90) 

51.  General  Conversation 

A.  In  a  group  of  two  people,  talk  on  assigned 
topics  of  conversation,  with  material  prepared  be- 
forehand. 

B.  Then  with  three  people,  and  so  on,  gradually 
increasing  the  number  in  the  group. 

C.  Gradually  bring  in  strangers. 

D.  Same  as  A,  with  topics,  not  priepared  beforehand 
(impromptu  conversation).    .  


EXERCISES  223 

E.  Same  with  three  or  more  people. 
.  F.  Same  with  strangers. 

52.  Coolness  in  Argument 

A.  Argue  a  question  with  the  instructor. 

B.  Argue  a  question  with  somebody  else. 

C.  Argue  a  question  in  a  group  of  three. 

D.  Debate  a  topic  with  some  person  before  a  small 
group. 

E.  Debate  a  political  question  with  interruptions 
from  the  audience. 

53.  Transacting  Business 

A.  Sitting  at  a  desk,  you  ring  a  bell  as  a  signal  for 
a  person  to  enter.  As  he  approaches  your  desk,  you 
greet  him  and  ask  him  what  he  wants.  If  he  is 
applying  for  a  position,  inquire  into  his  qualifications 
and  then  dismiss  him;  if  he  wants  to  buy  or  sell  or 
transact  some  other  business,  you  are  to  promptly 
settle  the  matter,  speaking  very  slowly  and  melodi- 
ously. A  series  of  persons  is  interviewed  in  hke 
manner. 

B.  You  are  to  take  the  part  of  the  person  entering 
the  office  for  business.         . .,,. 


224  STUTTERING  AND   LISPING 

SET  XVI 

EELAXATION    (p.  61) 

54.  General  Relaxation 

A.  Lie  on  a  couch,  close  your  eyes,  and  purposely 
try  to  relax  every  limb. 

B.  Some  one  passes  his  hands  over  the  various 
Hmbs,  feeling  that  the  muscles  are  all  relaxed.  This 
is  repeated  four  or  five  times  at  intervals  of  about 
fifteen  minutes. 

C.  Get  your  mind  fixed  on  the  thought  of  relaxa- 
tion and  quietness.  Lie  perfectly  quiet  in  this  way 
for  five  minutes  on  the  first  occasion,  for  ten  minutes 
on  the  next,  and  so  on  for  an  increasing  length  of 
time  up  to  a  half  hour. 

55.  Speaking 

A.  You  are  to  lie  on  a  couch  in  a  relaxed  condition. 
Some  one  speaks  a  sentence  to  you  very  slowly  and 
melodiously ;   you  are  to  repeat  it  Hkewise. 

B.  Repeat  sentences  and  reply  to  questions  in  the 
usual  way  (p.  92). 

C.  Exercises  in  description  and  relation  (p.  219)  are 
carried  out  in  this  relaxed  condition. 


EXERCISES  225 

SET  XVII 

MUSCULAR   CONTROL 

56.  Tongue  Gymnastics  (p.  160) 

A.  Thrust  the  tongue  out  and  draw  it  back 
quickly ;  do  the  same  slowly. 

B.  Move  the  tongue  from  side  to  side  outside  of 
the  mouth,  first  slowly,  then  quickly. 

C.  Same  inside  of  the  mouth. 

D.  Touch  the  point  of  the  tongue  to  the  upper  Up. 

E.  Touch  the  point  of  the  tongue  to  the  roof  of 
mouth,  keeping  the  mouth  open;  same  with  the 
mouth  shut. 

F.  Touch  the  point  of  the  tongue  to  the  upper 
front  teeth. 

G.  Place  the  thumb  and  finger  on  each  side  of 
the  tongue ;  broaden  and  narrow  the  tongue  by  use 
of  the  muscles  within  the  tongue ;  this  is  felt  by  the 
fingers. 

H.  Place  the  thumb  and  finger  below  and  above 
the  tongue ;  repeatedly  thicken  the  tongue ;  this  is 
felt  by  the  fingers. 


226  STUTTERING   AND    LISPING 

57.  Lip  Gymnastics 

A.  Without  projecting  the  hps,  alternately  con- 
tract them  to  a  round  circle  while  saying  "oh/* 
and  draw  the  corners  back  while  saying  ''eh.'' 

B.  Same,  on  different  tones. 

C.  Same,  speaking  sentences. 

58.  Relaxing  the  Jaw  (p.  83) 

A.  Place  the  hands  at  the  back  of  the  cheeks; 
notice  the  swelling  of  the  masseter  muscles  during 
speech ;  relax  them  by  dropping  the  jaw. 

B.  Speak  the  vowels,  dropping  the  jaw  at  the  same 
time. 

C.  Speak  sentences,  dropping  the  jaw  as  much  as 
possible. 

D.  Leave  the  mouth  open  for  long  periods  of 
time.  4 

59.  Fixation  of  the  Larynx  (p.  83) 

A.  With  the  fingers,  press  backward  and  down- 
ward on  the  hyoid  bone ;  resist  its  rising  while  you 
pretend  to  swallow. 

B.  Sing  "ah,"  pressing  the  hyoid  bone  backward; 
alternate  in  singing  "ah"  with  and  without  pressing. 


EXERCISES  227 

Try  to  make  the  ^'  ah  "  without  pressing  sound  like 
the  ''  ah  "  with  pressing. 

C.   Speak  vowels,  words,  and  phrases  as  in  B. 

60.   Jaw  Position 

A.  Insert  two  fingers  vertically  between  the  teeth ; 
speak  the  vowels  in  this  position;  speak  sentences 
also. 

B.  While  looking  in  a  mirror,  speak  all  the 
vowels,  keeping  the  mouth  as  widely  open  as  before, 
or  nearly  so. 

C.  With  the  mirror,  speak  sentences,  opening  the 
mouth  as  widely  as  before  on  the  broad  vowels, 
such  as  '^ah"  and  ''oh." 

61.   Rear  Palatal  Arch  (p.  84) 

A.  Look  in  the  mirror;  observe  the  rear  palatal 
arch;  whisper  ''ah"  softly  and  loudly  alternately; 
observe  that  the  arch  is  narrow  for  the  loud  whisper. 

B.  Try  to  narrow  the  arch  by  a  voluntary  effort 
without  whispering. 

C.  When  the  ability  to  narrow  the  arch  is  obtained, 
sing  out  a  loud  "ah"  at  the  moment  of  narrowing. 

D.  Same  with  other  vowels. 

E.  Same,  speaking  the  vowels. 


228 


STUTTERING  AND   LISPING 


SET  XVIII 

WORD   LISTS 

62.  Wards  beginning  with  ^^p" 


pack 

pay 

pie 

play 

post 

pad 

peel 

piece 

plum 

pound 

paint 

pear 

pink 

point 

pour 

pair 

pen 

plain 

pole 

preach 

63.  Wards  ending  vnth  ^'p" 

ape 

deep 

help 

loop 

rope 

cape 

drape 

keep 

map 

stop 

cap 

grape 

lap 

mop 

tape 

cheap 

hope 

leap 

nape 

top 

64.  Words  with  ''p'' 

in  the  middle 

appeal 

approach  dipper 

lisping 

reply 

appear 

apron 

dripping 

repeat 

report 

apple 

chapel 

happen 

repel 

reproac 

appoint 

clapper 

helping 

repent 

ripple 

65.  Words  beginning  with  "6' 

>> 

bad 

band 

bead 

bend 

bite 

bag 

bank 

bear 

bet 

black 

bake 

bark 

bed 

bill 

blank 

ball 

bat 

bee 

bind 

bloom 

EXERCISES 


220 


66.  Words  ending  with  ^'6" 

Arab  crab  drab  sob  tub 

babe  crib  garb  stab  tube 

bribe  cube  grab  stub  verb 

cab  daub  probe  tab  web 

67.  Words  with  ''&"  in  the  middle 


cable 

lobster 

obey 

obtain 

rubber 

dribble 

marble 

object 

rabbit 

stumble 

fable 

medal 

obscure 

ribbon 

tumble 

labor 

nibble 

observe 

robbin 

warble 

68.  Words  beginning  with  'H^^ 

table  tame  tell  town  trust 

tack  tape  test  trade  tune 

take  taste  toe  train  twist 

talk  tea  top  trunk  twine 


at 
ate 
bat 
bit 


69.  Words  ending  with  "^" 

boat  fat             not            rate 

cat  fit              nut            rust 

coat  get            ought        what 

eat  hit            put           wet 


230 


STUTTERING   AND    LISPING 


70.  Words  with  'W  in  the  middle 


attach 

attire 

fatal 

mutter 

tattle 

attack 

battle 

fitting 

outer 

utter 

attain 

bitter 

letter 

patter 

vital 

attend 

butter 

matter 

rattle 

water 

71.   Words  beginning  with  '' 

^d" 

dance 

date 

debt 

desk 

dive 

dare 

day 

deep 

dew 

dog 

dark 

dead 

dell 

dim 

doll 

dash 

deaf 

depth 

dine 

draft 

72.  Words  ending  with  "d^^ 

add  fed  lid  mud  road 

bad  glad  load  odd  rude 

bed  had  mad  pad  sad 

bid  lead  made         raid  sled 


73.  Words  with  ^^c?"  in  the  middle 

address  bondage  childish  endless  fiddle 

adept  boulder  conduct  fading  gladden 

binding  cadet  cradle  federal  harden 

bundle  cedar  edition  feeding  widen 


EXERCISES 


231 


74.  Words  heginning  with  '^k 


cab 

crop 

cuff 

keep 

kind 

catch 

cross 

cup 

key 

king 

care 

cry 

cure 

kick 

kiss 

creep 

cube 

cut 

kill 

kite 

75.  Words  ending  with  "k^^ 

ache  bleak         flake  neck  pick 

bake  cake  kick  oak  pluck 

beak  duck  like  pack  risk 

beck  drake        make         peck  stick 


76.  Words  with  "k^^  in  the  middle 
flicker        looking      occur         raking 


aching 

baker  knuckle  market 

barking  leaking  masker 

drinking  locket  milky 


occur 

package  scrape 

picture  scream 

picnic  screw 


77.  Words  heginning  with  '^g^^ 

gain  gay  girl  glance  globe 

game  get  give  glare  glow 

gas  gift  glad  glass  go 

gate  gild  glade  gleam  gold 


232 


STUTTERING  AND   LISPING 


>) 


78.  Words  ending  with  ^^g 

bag  clog  egg  pig  tag 

beg  dig  fog  rag  tongue 

big  dog  frog  rug  tug 

bug  drag  mug  sting  wig 


79.  Words  with  ^'g^^  in  the  middle 

again  agony  argue  bungle      longer 

aggrieve  agree  baggage  digging     organ 

aghast  anger  braggart  dragging  program 

aglow  angle  bugle  laggard     rugged 

80.  Words  beginning  with  "ch^^ 

chain  chap  cheer  chill  chisel 

chair  cheap  chicken  chimney  chocolate 

chalk  cheat  chief  chin  choke 

change  check  child  chip  chop 


81.  Words  ending  with  *'  ch^^ 

batch         crutch      much        pitch  Scotch 

beach         grouch      notch        pouch  screech 

botch         latch        peach        preach  smirch 

church        lurch         perch        reach  such 


EXERCISES 


233 


82.  Words  with  '^  ch'^  in  the  middle 

bleaching  hitching  perching   Scotchman  twitching 

butcher      itching  pitcher      screeching  urchin 

etcher         latching  preacher    searching  watcher 

fetching     lurching  scorching  teacher  witching 


Jack 
jail 
jam 
jar 


83.  Words  beginning  with  "j 


>j 


jaw 
jerk 
jet 
jewel 


Jig 
job 

jockey 
John 


joint 
joke 
jury 
judge 


jug 
jump 

joy 

justice 


84.  Words  ending  with  "  j'^ 

age  dodge       hedge  porridge  sledge 

bridge         dredge      judge  purge  smudge 

budge         edge  lodge  rage  stage 

courage      fringe        marriage      sage  urge 


85.  Words  with  "  j'^  in  the  middle 

adjoin  engaging    language      regent  Roger 

arranging    enjoy  luggage         reject  stranger 

baggage      ginger         manger         rejoice  tinged 

conjurer       injury        prodigious    religious  unjust 


234  STUTTERING   AND   LISPING 

86.  Words  beginning  with  ''f^^ 

face  fair  fame  fast  fight 

fact  faith  fan  fault  fine 

fail  fall  fare  feel  fire 

faint  false  farm  fell  fish 

87.  Words  ending  with  "f^' 

bluff  elf  hoof  life  rough 

chafe  grief  if  muff  safe 

cliff  gruff  laugh  off  snuff 

cuff  half  leaf  puff  stuff 

88.  Words  with  ^^/"  in  the  middle 

affair         buffet        effect         lofty    ,      puffy 
affect         coffee        effort         offer  roughen 

afford         differ         laughter    office         stuffy 

afraid        efface        lifting        often  toughen 

89.  Words  beginning  with  ''«?" 

vain  voice  value 

verb  void  vapor 

vest  vote  very^B; 

vine  valley  vigor 


vague 

van 

vain 

vast 

vale 

vault 

valve 

veil 

EXERCISES 


235 


90.  Words  ending  with  ^'v^' 

above        dive  glove         live  save 

brave         drive         groove       move  valve 

cave  five  grove         pave  wave 

crave  give  have  rave  weave 


91.  Words  with  "v'^  in  the  middle 

having        never 
level  over 

lever  river 

movement  silver 


braver 

event 

evince 

diving 

'    ever 

favor 

evade 

every 

fever 

even 

evil 

flavor 

92.  Words  beginning  with  '^  s  " 

sack  same  seed  sin  slate 

sad  school  sell  since  slave 

safe  scrub  set  sit  sleep 

sail  sea  silk  skate  slice 


93.  Words  ending  with  ^^s" 

base  dress         kiss  loose  race 

brass  face  -lace  miss  rice 

case  grease        lease  moss  slice 

crease        hiss  loss  place  us 


236 


STUTTERING  AND   LISPING 


94.  Words  with  "s^'  in  the  middle 

ascent  assign  astray  dresser  listen 

aside  assist  basket  essaj^  loosen 

asleep  assure  biscuit  essence  master 

assay  astir  casket  fasten  tasty 

95.  Words  beginning  with  "z^^ 


zeal 

zone 

zenith 

zither 

zoolo 

zest 

zoo 

zero 

Zion 

Zeu3 

zinc 

zebra 

zigzag 

zouave 

Zulu 

zodiac 

zephyr 

zounds 

96.  Words  ending  with  ^'z^' 

bees 

daze 

his 

maze 

seize 

breeze 

freeze 

has 

nose 

size 

cries 

graze 

haze 

praise 

tease 

craze 

hers 

lose 

rise 

trees 

97.  Words  with  '^z^^  in  the  middle 


busy 

dizzy 

grisly 

losing 

result 

breezy 

dozen 

hazy 

nasal 

resume 

bruising 

fuzzy 

lazy 

prison 

scissors 

cozy 

freezing 

Uzard 

prize 

weasel 

EXERCISES  237 

98.  Words  beginning  with  ^'sh^'  (surd) 

shade  shame  shed  ship  shore 

shaft  shape  sheet  shock  short 

shake  share  shelf  shoot  show 

shall  sharp  shell  shop  shut 

99.  Words  ending  with  ^'sh'^  {surd) 

ash  dish  lash  rash  trash 

bush  fish  mash  sash  thrush 

cash  flash  push  slash  wash 

dash  fresh  plush  smash  wish 

100.  Words  with  "sh^^  (surd)  in  the  middle 

ashes  bushel       crashing  flashing     rashly- 
bashful  bushy        crushing  flushing     rushing 
blushing  cashier      dashing  hushing    washing 
brushes  clinching  fishy  freshness  pushing 

101.  Words  with  "sh^^  (sonant) 

adhesion  delusion  evasion    Parisian     seizure 

azure  derision  invasion   pervasion  treasure 

cohesion  division  leisure      pleasure     vision 

decision  elision  measure   precision    visual 


238 


STUTTERING   AND    LISPING 


102.  Words  beginning  with  "th^^  (surd) 

thank  thin  thirst  three  throb 

thaw  thing  thorn  thrift  throw 

thick  think  thought  thrill  thrust 

thief  third  thread  throat  thud 

103.  Words  ending  with  "th^^  (surd) 

bath  broth  faith  month  tooth 

bhthe  death  fourth  moth  width 

both  depth  fifth  mouth  wrath 

breath  earth  lithe  path  wroth 

104.  Words  with  "th^^  (surd)  in  the  middle 

athirst  bathos  ethereal    monthly  southerly 

athlete  earthly  lengthen   pathway  strengthen 

athwart  Ethel  Matthew  pathetic  youth 

author  ether  method     pathos  zither 

105.  Words  beginning  with  "th^^  (sonant) 


than 

them 

they 

this 

thus 

that 

then 

these 

thou 

they 

the 

there 

thine 

though 

therefore 

EXERCISES 


239 


106.  Words  ending  with  "th''  (sonant) 

bathe  clothe  lathe  soothe 

breathe      swathe  smooth  loathe 

107.  Words  with  "th^^  (sonant)  in  the  middle 

another      brother  further  lather  panther 

bathing      either  gather  leather  rather 

bother        father  heather  neither  together 

breathing  feather  mother  other  weather 

108.    Words  beginning  with  ^'  w  '^ 


wad 

weak 

wish 

willow 

wafer 

wag 

wealth 

wit 

wily 

wager 

waif 

wear 

wolf 

wince 

wagon 

wail 

wax 

worn 

wife 

waJSle 

109.    Words  with  "  w^^  in  the  middle 


awake 

bower 

V  jewel     7 

rower 

towel 

aware 

cower 

lower      > 

sewer 

tower 

bewail 

dowry 

rnowing 

slower 

trowel 

bewitch 

fewer 

power 

sowing 

vowel 

240 


STUTTERING  AND   LISPING 


110.   Words  beginning  with  '^y^' 

yacht        yawn         yeast        yes  yoke 

yard  ye  yell  yesterday  you 

yarn         year  yellow       yet  young 

yawl         yearn         yelp  yield  youth 


i( « jf 


111.    Words  beginning  with  "r 


race 

rasp 

rid 

rob 

rule 

rack 

rat 

ride 

robe 

run 

raft 

rate 

ridge 

rock 

rung 

rag 

rave 

rig 

rod 

rush 

112.   Words  with  "r"  between  vowels 

arrow  errand  marry  narrow  terrace 

berry  ferry  merry  parrot  terror 

current  garret  mirror  pirate  turret 

direct  hurry  moral  sorry  worry 


113.   Words  with  ''r'' 

after  a 

consonant 

braid        bread 

drive 

dry 

fruit 

branch     break 

droop 

fraud 

fry 

brass        crab 

drop 

free 

grape 

brave       drip 

drum 

frost 

grease 

EXERCISES 


241 


114.    Words  beginning  with  'T^ 

lad  leaf  let  lion  long 

lake  leak  lick  lip  loose 

lame  lean  lie  live  lot 

lamp  left  limp  loaf  low 

115.    Words  ending  with  '^  l'^ 

animal  avail  bell  call  deal 

annual  owl  bewail  camel  dial 

appal  bail  bill  cereal  eel 

appeal  bawl  boil  chill  fool 

116.    Words  with  "  V^  between  vowels 

alarm  along  elegant  eleven  illegal 

alert  aloud  element  elope  illumine 

allow  alum  elephant  eloquent  illusion 

alley  elect  elevate  island  olive 


117.  Words  beginning  with  ^^m" 

machine  magnet  major  man  milk 

mad  maiden  maker  measure  monkey 

made  mail  malice  meat  move 

magic  mane  mama  meal  must 

R 


242 


STUTTERING  AND   LISPING 


118.  Words  ending  with  ^'m'' 

aim  gleam  jam  ream  some 

beam  gloom  lamb  rim  swim 

comb  gum  limb  room  thumb 

come  home  ram  seam  Tom 

119.  Words  with  "  m^^  in  the  middle 

amaze  company  limit  murmur  summer 

amount  dreamer  mama  plumber  summit 

bemoan  former  mimic  roomy  swimmer 

comma  hammer  moment  steamer  trimming 

120.    Words  beginning  with  "  n  " 


name 

niece 

no 

north 

nudge 

neck 

niche 

nod 

not 

number 

nest 

night 

noon 

note 

nurse 

nice 

nine 

noose 

now 

nutshell 

121.   Words  ending  with  "  n  " 

alone         dawn         John  pine  run 

balloon      fine  moan  pint  ruin 

bean  gone  moon  prune  sun 

brine  sun  pan  rain  win 


EXERCISES 


243 


122.    Words  with  "  n^'  in  the  middle 

Annie     corner  honor  panel  tender 

banner    counter  lining  render  whining 

bonny     dinner  money  running  winner 

briney     fountain  only  sooner  wonder 

123.  Words  with  ''  ng  " 

ailing        covering  having        nothing  ringing 

bending    caring  killing        pudding  singer 

being        counting  laughing    remaining  willing 

bringer     crawling  living         ring  wringer 


Plate  I.  -^  Mouth  Diagrams  for  Typical  English  Sounds. 


Plate  II.  —  Mouth  Diagrams  for  Typical  English  Sounds 


Plate  III.  —  Mouth  Diagrams  for  Typical  English  Sounds 


Qd  nd  ad 

a,D,A,o,u,u  a  85 

od  ad  a^ 


e 


ai  Ad  Ud 


t,d  k,§r 


tii  m  tXd 

4j  9.^^  s,z 

ad  ad  a(i 

J",  3  ^    •    ri  *  .  ^ 

Plate  ^V.  —  Palatograms  for  Typical  English  Sounds 


SELECTED  REFERENCES 

FOE   COMPLETE  WORKS   ON   THE  VOICE 

Rousselot,  Principes  de  la  phonetique  exp6rimentale,  Paris,  1897, 
1901 

Scripture,  Elements  of  Experimental  Phonetics  (Yale  Bicen- 
tennial Series),  New  York,  1902 

FOR   THE   PRINCIPLES   OF   PHONETICS 

Sievers,  Grundztige  der  Phonetik,  Leipzig,  1901 

Vietor,  Elemente  der  Phonetik,  Leipzig,  1904 

Victor,  Kleine  Phonetik,  Leipzig,  1907 

Grandgent,  German  and  EngUsh  Sounds,  Boston,  1892 

Sweet,  Primer  of  Phonetics,  Oxford,  1890 

Jones,  The  Pronunciation  of  Enghsh,  Cambridge,  1911 

FOR   SPEECH  DEFECTS 

Gutzmann,  Sprachheilkunde,  2  ed.,  BerUn,  1912 

Kussmaul,  Die  Storungen  der  Sprache,  Leipzig,  1885;  4  ed.,  1910 

Liebmann,   Vorlesungen  iiber  Sprachstorungen,   Berlin,    1898- 

1906 
Rouma,  La  Parole  et  les  troubles  de  la  parole,  Paris,  1907 

FOR  ACCOUNTS   OF   STUTTERING 

Gutzmann  (A.),  Das  Stottern,  6  ed.,  Berlin,  1910 
Gutzmann  (H.),  Das  Stottern,  Frankfort-a-M,  1898 
Liebmann,  Stotternde  Kinder,  Berlin,  1903 

245 


246  STUTTERING  AND   LISPING 

FOR   PSYCH  ANALYSIS 

Freud,  Traumdeutung,  Leipzig- Wein,  1911 

Freud,  Selected  Papers  on  Hysteria  and  other  Psychoneuroses, 

(Brill),  New  York,  1909 
Freud,  The  Origin  and  Development  of  Psychanalysis,  Clark 

University,  Worcester,  1910 
Jung,  Diagnostische  Associationsstudien,  etc. 
Stekel,  Nervose  Angst zustande,  Berlin- Wien,  1908 
Stekel,  Die  Sprache  des  Traumes,  Wiesbaden,  1911 
White,  Mental  Mechanisms,  New  York,  1912 

TECHNICAL  TERMS 

Cluttering — The  disease  described  on  p.  187. 

Deltacism — Defective  pronunciation  of  "t"  and  ''d"  (p.  127). 

Frontal  sigmatism  —  See  simple  sigmatism. 

Gammacism — Defective  pronunciation  of  "k,"  "g"  (p.  128). 

Lambdacism — Defective  pronunciation  of  "1"  (p.  149). 

Lateral  parasigmatism — See  lateral  sigmatism. 

Lateral  sigmatism —  Producing  "s"  and  "z"  with  side  opening 

(p.  133). 
Lisping — The  group  of  diseases  described  in  Part  II ;  another  use 

of  the  word  confines  it  to  simple  sigmatism. 
Nasal  parasigmatism — See  nasal  sigmatism. 
Nasal   sigmatism  —  Producing  "s"  and ''z'' with  open  passage 

through  the  nose  (p.  151). 
Negligent  lisping — The  disease  described  on  p.  122. 
Neurotic  lisping — The  disease  described  on  p.  173. 
Organic  lisping — The  disease  described  on  p.  162. 
Paragammacism — Substitution  of  other  sounds  for  *'k"  and  "g" 

(p.  128). 


TECHNICAL  TERMS  ,  247 

Paralambdacism  —  Substitution  of  other  sounds  for  "1"  (p.  149). 
Pararhotacism  —  Substitution  of  other  sounds  for  "r"  (p.  146). 
Parasigmatism  —  Substitution  of  other  sounds  for  "s"  and  "z" 

(p.  134). 
Rhinolalia  —  Defective  action  of  the  nasal  cavities  in  producing 

sounds  (p.  150). 
Rhinolalia' aperta  —  Rhinolalia    with    improperly    opened    nasal 

cavities  (pp.  150;  168). 
Rhinolalia  clausa  —  Rhinolalia  with  improperly  obstructed  nasal 

cavities  (p.  170). 
Rhotacism — Defective  pronunciation  of  "r"  (p.  146). 
Sigmatism — Defective  pronunciation  of   ''s"  and   "z";   also 

sometimes  defective  pronunciation  of  "sh"  (pp.  130,  140). 
Simple  sigmatism  —  Defective  pronunciation   of  ''s"  and   "z" 

whereby  the  sound  of  "th"  is  produced ;  the  term  lisping  is 

often  limited  to  this  defect  alone  (p.  134). 
Stammering  —  Stuttering. 
Stuttering  —  The  disease  described  in  Part  I. 


INDEX 


Abdominal  movements  recorded,  24. 
Adenoids,  170. 
Akxomegaly,  165. 
Anxiety  neurosis,  7. 
Aphonia,  hysterical,  49. 
Argument,  223. 
Artificial  palate,  115. 
Association  of  ideas,  87,  217. 

Belief  in  success,  66. 
Breath  indicator,  118,  153. 
Breathing,  84,  190. 
Breathy  voice,  81. 
Bulbar  paralysis,  62. 
Business,  223. 
Buying,  212. 

Candle  flame  indicator,  117. 
Censorship,  100. 
Character  in  stuttering,  20. 
Chest  movements  recorded,  22. 
Choreatic  stuttering,  47. 
Class  work,  72, 
Clear  endings,  28. 
Cleft  palate,  168. 
Clinic  treatment,  72. 
Cluttering,  46,  187. 
Colds,  171. 

Collection  of  ideas,  216. 
Compulsi\e  act,  37. 
Confidence,  13,  90,  210. 
Contagiousness  of  stuttering,  7. 
Continued  story,  212. 
Control  of  the  voice  by  ear,  196. 
Conversation,  222. 
Coolness  in  argument,  223. 
Correct  enunciation,  65. 
Correct  thinking,  64. 
Correction  of  character,  66. 
Coup  de  glotte,  see  Glottal  catch. 
Cramps  in  stuttering,  10. 


Defective  enunciation,  see  Lisping. 
Defective  hearing,  171. 
Deflected  septum,  170. 
Denasalization,  170. 
Description,  219. 
Diagnosis  of  stuttering,  42. 
Disease  as  a  cause  of  stuttering,  8. 
Dreams,  103. 
Drum,  23. 

Embarrassment,  3,  15,  17,  217. 
Emphasis,  208. 
Emphasizing  periods,  206. 
Ending,  205. 
Enunciation,  88,  207. 
Equilibration  of  character,  63. 
Exercises,  69,  190. 
Exhaustion  as  a  cause  of  stutter- 
ing, 8,  16. 
Experimental  phonetics,  22. 
Explosives,  117. 
Expression,  208. 

Fear  as  a  cause  of  stuttering,  6. 

Feeble  lips,  162. 

Fixation  of  the  larynx,  226. 

Flame  indicator,  119. 

Flexibility,  74,  197. 

Flurry,  14. 

Forms  of  stuttering,  15. 

Freud,  7,  67. 

Fricatives,  117. 

Fright  stage  of  stuttering,  118. 

Functional  lisping,  123. 

General  anxiety  neurosis,  7. 
General  conversation,  222. 
General  indistinctness,  157. 
General  paralysis,  54. 
Glottal  catch,  81. 


249 


250 


INDEX 


Habit  formation,  61. 

Habit  stage  of  stuttering,  15. 

Hare  lip,  162. 

Hemiatrophy  of  the  tongue,  163. 

Hereditary  ataxia,  52. 

High  palatal  arch,  167. 

Hoarse  voice,  81. 

Hoarseness,  81. 

Home,  the  stutterer  at,  4,  57. 

Husky  tone,  204. 

Hyperphonia,  12. 

Hypertonicity,  12. 

Hysteria,  48. 

Hysterical  aphonia,  49. 

Hysterical  mutism,  48. 

Ideas,  collection  of,  216. 
Imitation  as  a  cause  of  stuttering,  7. 
Increasing  embarrassment,  62. 
Indifferent  stage  in  stuttering,  19. 
Infantile  cerebral  palsy,  49. 
Insanity,  55. 

Institutional  treatment,  71. 
Intellectual  disturbance  in  stutter- 
ing, 65,  119. 
Introducing,  213. 

Jaw  defects,  165. 
Jaw  position,  227. 

Kussmaul,  34,  52. 

Laryngeal  tone,  11,  23,  74. 

Larynx,  fixation  of,  226. 

Larynx  defects,  155. 

Lengthened  vowels,  199. 

Linking,  201. 

Lip  defects,  124. 

Lip  gymnastics,  163,  226. 

Lip  movements  recorded,  25. 

Lip  reading,  172. 

Lips  in  connection  with  lisping,  162. 

Lisping,  as  a  cause  of  stuttering, 
17,164;  defined.  Ill;  negligent, 
122  ;  organic,  162  ;  neurotic,  173. 

Loudness  of  voice,  98. 

Lowering  tones  at  end,  206. 

Megaphone,  204. 
Melody,  74,  194. 


Melody  cure,  77. 
Melody  plot,  33. 
Mental  cramp,  97. 
Mental  daze,    see  Intellectual   dis- 
turbance. 
Mental  flurry,  14. 
Metronome,  200. 
Monotony,  11,  33. 
Motor  aphasia,  50. 
Mouth  recorder,  25. 
Multiple  sclerosis,  .52. 
Muscular  action,  defects  of,  83. 
Muscular  control,  225. 
Muscular  dystrophy,  163. 
Mutism,  hysterical,  48. 

Nasals,  118. 

Nature  of  stuttering,  34. 
Negligent  lisping,  43,  112. 
Neurotic  lisping,  145,  173. 
New  method  of  speaking,  57. 

Occlusives,  117. 

Octave  twist,  78,  192. 

Office  treatment,  67. 

Operation  as   a   cause  of  stuttes 

ing,  6. 
Organic  lisping,  43,  162. 
Organs  of  enunciation  and  phoua. 

tion,  113. 
Overshot  jaw,  165. 
Overtension  in  stuttering,  12. 

Palatal  arch,  227. 

Palate  defects,  167,  168,  170. 

Palatography,  114. 

Penmanship  stuttering,  38. 

Periods,  206. 

Phobia,  38. 

Phonetic  alphabet,  112. 

Phonetics,  22. 

Pneumograph,  22. 

Principles   for   treating   stuttering, 

57. 
Progressive  bulbar  paralysis,  52. 
Prophylaxis  of  stuttering,  8. 
Pseudobulbar  paralysis,  53. 
Psychanalysis,  67,  69,  101. 
Psychoneurosis,     stuttering     as     a 

form  of,  7. 
Public  speaking,  214. 


INDEX 


251 


Quality  of  voice,  81. 

Reading,  94,  192. 

Reading  together,  210. 

Reading  with  decided  voice,   211. 

Readjusting  the  subconscious,  100. 

Readjustment  of  environment,  98. 

Rear  palatal  arch,  227. 

Recording  drum,  23. 

Recording  tambour,  22. 

References,  245. 

Relation,  220. 

Relaxation,  61,  224. 

Relaxed  palate,  170. 

Relaxing  the  jaw,  226. 

Running  associations,  104,  109,  219. 

School,  the  stutterer  at,  3. 

School  work,  215. 

Sentences  for  indistinctness,  159. 

Septum,  170. 

Shock  as  a  cause  of  stuttering, 
6,  16. 

Singing,  90,  91,  192,  197. 

Slowness,  85,  198. 

Smoothness,  201. 

Social  timidity,  39. 

Sonants,  118. 

Spasms  in  stuttering,  10, 

Spastic  speech,  49. 

Speaking,  92,  193,  198,  224. 

Speaking  together,  211. 

Speaking  wilji  confidence,  211. 

Speech  clinic,  72. 

Spelling,  208. 

Spontaneous  speech,  94,  216. 

Stages  of  stuttering,  15. 

Stammering,  44. 

Starting,  201,  205. 

Statement  and  question  exercise, 
193. 

Statistics  of  stuttering,  9. 

Strengthening  first  word,  205. 

Stuttering,  description,  1 ;  det- 
riment to  welfare,  2  ;  at  school, 
3 ;  at  home,  4 ;  a  disease,  4 ; 
regarded  as  a  habit,  5 ;  causes, 
5;    connected  with  nervousness, 


6 ;  contagiousness,  7 ;  after 
exhaustive  diseases,  8 ;  pro- 
.  phylaxis,  8  ;  statistics,  9  ;  symp- 
■  toms,  10  ;  forms  or  stages  of,  15  ; 
habit  stage,  15 ;  fright  stage, 
18 ;  indifferent  stage,  20 ;  con- 
nection with  character,  20 ;  ex- 
perimental study  of,  22 ;  na- 
ture of,  34  ;  Kussmaul's  theory, 
34 ;  relation  to  other  neuroses, 
37 ;  author's  theory,  38 ;  dif- 
ferential diagnosis,  42 ;  therapy, 
56. 

Subconscious,  70. 

Subconscious  readjustment,  67. 

Talking  with  people,  222. 

Tambour,  22. 

Tambour  indicator,  121. 

Technical  terms,  246. 

Telephoning,  96,  221. 

Theory  of  stuttering,  36. 

Therapy  of  stuttering,  56. 

Thinking,  86,  217. 

Tic,  37. 

Tic  speech,  47. 

Tissue  paper  indicator,  153. 

Tone  of  voice,  see  Laryngeal  tone. 

Tone  placing,  202. 

Tongue  defects,  163. 

Tongue  gymnastics,  160,  225. 

Tongue  movements  recorded,  25. 

Tongue-tie,  18,  43,  164. 

Tooth  defects,  165. 

Transacting  business,  223. 

Trumpet,  204. 

Turbinates,  170. 

Undershot  jaw,  165. 

Velar  hook,  153. 

Velum  defects,  150,  168. 

Vocal  quality,  81,  202. 

Voice   tone,    see    Laryngeal    tone. 

Vowels,  116. 

Word  lists,  228. 
Writer's  cramp,  38. 


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questions  and  of  promoting  to  a  wiser  cooperation  with  church, 
school,  and  the  medical  profession  in  safeguarding  their  own  — and, 
we  may  hope,  all  other  —  children  against  blunders  and  contamina- 
tions. 

THE  MACMILLAN  COMPANY 

Publishers  64-66  Fifth  Avenue  New  Tork 


COLUMBIA  UNIVERSITY  LIBRARIES 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

- 

-    9.  n  %.:. 

^•li 

W      3  19*E 

C28(1  140)M100 

~  "Krr" 


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£LjL 


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